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NCT

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How do I Support my Partner During Labour?

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NCT

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Share your videos with friends, family, and the world

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Radio 4 programme

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Today it's assumed that a dad should be there for the birth of his child. But what's the real impact of birth on dads and should they have more of a choice? Fi Glover investigates.

Sixty years ago, fewer than 15% of fathers were present at their child's birth. Today 98% are there. It's a cultural change that has been almost universally accepted. But the impact on dads has also gone largely un-examined.

Fi Glover meets dads who have experienced extremely different births. Most say that being there was the most momentous event of their lives. But, in private, some will also say the experience was one of the most bewildering and frightening.

Using special access to a maternity ward in London Fi Glover meets a father whose son was born prematurely at 27 weeks. He was offered support from the hospital's counselling unit in the weeks afterwards. But it's only in the last couple of years that perinatal counselling has become available to dads at all.

In Newcastle Dan Wilde recently found himself playing midwife when his partner Kate gave birth very quickly at home. His experience, backed recently by research from the Fatherhood Institute, shows how active participation during a birth can correlate with a lowering of anxiety. Theirs was a positive experience.

But what happens when fear and circumstance turn the dad into a spectator rather than a participant? Mark Williams, whose son was born via emergency caesarean section, was eventually diagnosed with PTSD related to birth trauma. He has become a campaigner for better awareness around paternal mental health and suggests that screening might have helped to protect him from an experience he was unable to cope with.

Produced by Sarah Cuddon
A Somethin' Else Production for Radio 4

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BBC Radio 4 - Dads and the Delivery Room

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Today it's assumed that a dad should be there for the birth of his child. But what's the real impact of birth on dads and should they have more of a choice? Fi Glover investigates. Sixty years ago, fewer than 15% of fathers were present at their child's birth.

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Caesarean information for birth partners 

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Caesarean information for birth partners 

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OAA

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During an elective (planned) caesarean birth, there is usually no rush when your baby is born. If agreed beforehand, the obstetrician can lie your baby down before cutting the cord to help give the baby extra blood cells from the placenta (delayed cord clamping). If you wish they might hold your baby up above the screen for you to see.

He or she may not cry immediately after they are born. Don't worry. The paediatrician (baby doctor) or your midwife will give them any care they need. Once baby is breathing well and looks well, they will bring baby to you. If they have concerns, they may take your baby to the Special Care Baby Unit (SCBU). As soon as they can they will tell you how your baby is and explain what they are doing

If all is well, your midwife may ask your partner if she would like 'skin to skin ' with your baby lying directly on her chest. This can help keep your baby warm and give an early time for bonding. If she does, your midwife will help get a comfortable and safe position. Otherwise your midwife can wrap your baby in a towel for you or your partner to cuddle.

As the operation finishes, a member of the team will show where you can change back into your own clothes while you wait for them.

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During an elective (planned) caesarean birth, there is usually no rush when your baby is born. If agreed beforehand, the obstetrician can lie your baby down before cutting the cord to help give the baby extra blood cells from the placenta (delayed cord clamping).

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Woosh! A little book for birth companions

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Woosh! A little book for birth companions

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Katie Brooke

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Whoosh!: A little book for birth companions

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Pinter & Martin is an independent publishing company specialising in pregnancy, birth, parenting, breastfeeding, yoga and psychology books

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Mark Harris

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There's a wealth of information out there for expectant mums on pregnancy and birth, but so often the dad is left out of the conversation. Male midwife Mark Harris seeks to redress the balance with this new book, drawing on his decades of experience with couples as they make the transition to being new parents.

Covering topics from massage to sex, and pain relief during labour to breastfeeding, this is a lively, honest and frank discussion of pregnancy and birth from a man's point of view. Mark explores how to harness the power of birthing hormones, how to remain calm and aware in the birthing room, how to communicate effectively, and ultimately how to live the process of becoming a father to the full.

Your review has been submitted successfully.

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Men, Love & Birth by Mark Harris, Denis Walsh | Waterstones

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There's a wealth of information out there for expectant mums on pregnancy and birth, but so often the dad is left out of the conversation. Male midwife Mark Harris seeks to redress the balance with this new book, drawing on his decades of experience with couples as they make the transition to being new parents.

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Reducing your risk of perineal tears | RCOG

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The following animation explains what an OASI is, the four components of the OASI Care Bundle and how women can reduce their risk of sustaining an OASI in childbirth.

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Personalised Care and Support Planning in Maternity Services

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Personalised Care and Support Planning in Maternity Services

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NHS

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Personalised Care and Support Planning in Maternity Services

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NICE (June 2021)

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This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and people using services to work together to make decisions about treatment and care. It includes recommendations on training, communicating risks, benefits and consequences, using decision aids, and how to embed shared decision making in organisational culture and practices.

The guideline does not cover unexpected emergencies in which immediate life-saving care is needed. It also does not cover situations when, at the time a decision needs to be made, an adult does not have mental capacity to make a decision about their healthcare. For more information, see the NICE guideline on decision-making and mental capacity.

Recommendations

This guideline includes recommendations on:

Who is it for?

Everybody who delivers healthcare services

Commissioners of health and public health services

Adults (aged 18 and over) using healthcare services, their families, carers and advocates, and the public

It may also be relevant for:

Social care practitioners

Voluntary, community and social enterprise organisations

People who use social care services

Guideline development process
How we develop NICE guidelines
This guideline updates and replaces recommendations on shared decision making in NICE's guideline on patient experience in adult NHS services: improving the experience of care for people using adult NHS services (CG138, February 2012).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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This guideline covers how to make shared decision making part of everyday care in all healthcare settings. It promotes ways for healthcare professionals and

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NHS Decision making tool

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birthrights.org.uk (May 2021)

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Consent means saying yes. You have the right to make your own decisions about your body, just as you do at any other time.

It is against the law to give you medical treatment unless you agree to it. It is also against the law for treatment to be given to your baby without your consent or the consent of another person with parental responsibility.

Agreeing to treatment is known legally as giving consent. In law, your consent must be genuine. This means you must understand the treatment well enough to make a decision. It also means that no one, including your family or healthcare professionals must put pressure on you or bully you into agreeing to have the treatment.

If you are a surrogate you have the same rights as any other woman or birthing person to make decisions about your body.
You cannot be treated unless you agree
No one can treat or touch you against your will. Even if health professionals don't agree with your decisions about your body, they must respect them. Health professionals must ask if you agree to any medical treatment. For example, they must ask before examining you, before taking your blood pressure, and before giving you pain relief. This is the law.

If you do not agree to treatment, but health professionals still treat you, they may have broken the law.

The only time health professionals do not need your consent to treatment is when you are not able make a decision. It is very rare in law for someone to be unable to make their own decisions.

It could be because it is an emergency and you are unconscious. In this situation healthcare professionals must only give you treatment and care that you need to stay alive and safe.

Very rarely, you may not be able to give consent because you cannot understand the choice you need to make even when it is very clearly explained. This is called not having mental capacity. Our factsheet Mental capacity and maternity careexplains.

If you have particular communication needs or are worried about communicating, talk to your doctors and midwives so you can plan the best way for you to give or not give consent.

A healthcare professional must ask you before they examine you, investigate anything, or give you any care or treatment. You must be asked whether or not you agree to every medical procedure, even if it is as minor as taking your blood pressure. You don't have to speak to show that you agree. You could simply hold your arm out for the blood pressure cuff.

Remember that you do not have to agree. It is not your role to please healthcare professionals. It is their role to look after you in the way that you want. They must ask you every time they carry out a procedure (this includes things like blood tests, monitoring your blood pressure, internal examinations or offering you medication). Even if you consented to this examination or treatment before, they must ask you again. They must be clear about what they are asking.

For example, if your midwife wants to carry out a vaginal examination, they need to tell you in language that makes it clear that they will be putting their fingers inside you. Saying something like, 'Can you just hop up on the bed and we'll have a look and see how you are doing' is not clear. In addition, it is wrong for a healthcare professional to carry out further interventions; for example, I just did a "sweep" while I was there'. They should ask your permission in advance. (A sweep is an internal procedure which is intended to start labour.)

Making a birth plan and having respectful conversations with your healthcare professionals early in your pregnancy can help you think about the treatment and care you may be offered. You can specify in your birth plan any treatment you do not want.
For example, if you do not want vaginal examinations during your care, talk to your midwife about this during your antenatal care. Make sure your choice is written in your notes and birth plan. You do not have to say why you do not want to have vaginal examinations. If you are comfortable explaining why, this can help your midwives suggest care that may work for you.

If y ou do not think your healthcare professionals are listening to you when you refuse consent, you can contact us for advice.

At some point in your pregnancy and labour your healthcare professionals may think your care or treatment should change. If anything changes, they must tell you what is different and ask you again. If the treatment could now bring new risks or new benefits, they must ask your consent again.

You need to know who is giving you maternity care and agree. You must be asked before a medical student can be part of your care.

In some cases you might be asked for consent ahead of time. You can still change your mind afterwards.

If you are going to have an operation such as a planned caesarean section, the doctors should offer you a proper conversation about the risks and benefits ahead of time. They cannot do anything during the operation that you haven't agreed to unless it will save your life or prevent serious harm.

Even if you have discussed your care in advance, you should still be offered another discussion at the time of the procedure in case things have changed or you have changed your mind.
For example, if you have been booked for an induction you can change your mind and decline the induction at any time, including on the day of the procedure.
You do not have to agree to procedures simply because they are standard in this particular hospital or birth centre.

Before you decide about any care or procedure the healthcare professionals must give you information about what will happen.

The information should tell you about any risks that will be important to you. It should tell you if there are other treatments you could have instead and the risks and benefits of those. It should tell you what could happen if you don't have the treatment.

Your doctor should listen to you and find out what matters to you. For example, if a treatment or procedure might make future pregnancies complicated, they need to talk to you about how important it is to you to have more children so that you have the information you need to make a decision.

It is not enough just to give you a leaflet or a link to a website. You should also have a personal discussion with your healthcare professional.

You might want to use the BRAIN framework to help you get the answers you want:

B - What are the B enefits?

A - What are the A lternatives?

I - What does your I ntuition (gut) say about what's right for you?

N - What would happen if I said No or N ot now?

Your healthcare professional must not give you misleading information. The information must be up to date and based on the most recent evidence. They should give you as much information as they can to help you need to make a decision.

They must make it easy for you to ask questions, and they should answer your questions properly. If there is a question that they cannot answer, they should explain why (for example if the information isn't available). They may be able to help you find out information you need if it is available or point you to where that information might be.

If you need an interpreter or support to communicate the Trust should provide this.

You can ask for things to be explained again. It is ok to ask questions about what you were told and why during a previous appointment or during a previous pregnancy.

You have the right to request care but healthcare professionals do not always have to offer care if there is a good reason why they should not.

You should be listened to and taken seriously when you ask for care.
For example, if you ask for pain relief or for your pain relief to be topped up, it should be given unless there are good reasons against providing it. If there is a medical reason for refusing pain relief because it could cause you harm ('a clinical contraindication') then your doctor or midwife should explain this to you and document the discussion.
You can write a birth plan to tell people what care you want during labour and after. Your midwife or doctor should help you to make a birth plan that will be included within your maternity records.

You may also want to think about what is important to you and what you would like to happen in various situations. It can help you think about any boundaries you have, for example if you never want to be naked or be examined internally.

You can give your preferences, for example that you want your baby to be placed skin-to-skin with you after the birth.

Making your birth plan should be a collaboration between you and the health professionals supporting you, sharing information and finding out the best way to care for you and meet your wishes.

Your birth plan has no legal status, but if it has been agreed with your midwives and doctors then this should indicate that they are happy with it and will follow it. Even if you have chosen care that is not what they recommend, they should respect it and try to meet your wishes. A birth plan can be used in court as evidence of your wishes and the informed decisions you had taken at the time it was made.

If you have a disability any reasonable adjustments should be recorded in your notes/ birth plan. This could include, for example, room for your wheelchair in the birthing suite, lighting that lets you see better, a quiet or dark room to help with sensory overwhelm, or time after the birth to recover from fatigue. If you need reasonable adjustments under the Equality Act 2010, the Trust has to provide these.

No matter what you say in your birth plan you can change your mind and consent to different care at any time.

Your birth plan can include the role you want a birth partner or doula to play.

After giving birth, you can challenge the treatment you received. Your birth plan can be evidence of the consent you gave or did not give.

If there are medical reasons not to give you the treatment in your birth plan, your healthcare professionals should explain them.

Healthcare professionals have a duty to prevent suffering that can be avoided. They must not refuse you pain relief or other support simply because of a hospital guideline or policy.

Your healthcare professional's job is to explain the risks of treatment to you. They can recommend one treatment over others and give you their reasons for this. But they must not put pressure on you to choose a particular treatment for yourself or your baby.

If your healthcare professional puts pressure on you to make you choose a particular treatment, this is called undue influence.

Undue influence could mean that your healthcare professional keeps discussing risks even when you have made a decision.
For example, you may have decided that you do not want an induction. You discuss the risks and benefits with the midwife, who is worried about your decision. They call in the senior midwife, who repeats their concerns. Then the consultant obstetrician comes to see you and repeats them again. Unless the risks have changed and your health professionals want to give you new information, this may comprise undue influence.
It may also be undue influence if your health professional threatens to stop caring for you.
For example, if they said, 'Once you are 42 weeks pregnant the home birth team won't be able to come out to you and you will have to give birth in hospital' or 'If you don't agree to giving birth on the labour ward you will have to find another Trust to look after you.'
It may be undue influence if your healthcare professional tells you to make a decision by a certain time even when there is no clear medical need.
For example, they might say, 'You need to decide in the next twenty minutes' without explaining why.
They must not put pressure on people in your family to persuade you to change your mind.
For example, they might say to your partner, 'Try and talk them round. If it were my partner I wouldn't want them to do this. We only want what's best for your baby.'
They must not restrain you physically.

If your healthcare professional threatens to refer you to social services if you do not make the treatment decision they want, this is undue influence. They must never do this. If they do this, you may not legally have given consent. They could be taken to court if they went ahead and treated you.

If you have a disability or long-term illness, you may be worried that social services will take your baby away if you talk about any concerns you have about caring for your baby. They must work with you to find solutions, and you should never feel threatened.

If you are involved in the criminal justice system, you may feel worried that something you say could be used as an excuse to take your baby away. You have the same rights as everyone else and should never be threatened with social services merely because of your circumstances.

If you are in, or may go to prison during your pregnancy, the charity Birth Companions has a guide to pregnancy and early motherhood in prison.

If a woman is being treated for a mental disorder under the Mental Health Act 1983, or the Mental Health (Care and Treatment) (Scotland) Act 2003, that does not necessarily mean that she lacks capacity in relation to decisions about her maternity care. She should be treated in the same way as any other woman unless she has been assessed to lack capacity.

No. You can tell your healthcare professional that you agree to treatment. Or you can agree with a gesture, for example by holding out your arm so they can check your blood pressure.

Usually you will sign a consent form before surgery. Before you sign, you and your healthcare practitioner should talk about the treatment, the risks and the benefits.

It is important that you understand what you are consenting to, and the risks it brings.
For example, if you have a visual impairment and need to read in large print, ask for the form in large print and for plenty of time to read it.
A signed form and medical notes are evidence that you gave consent but not proof. Other evidence may show you did not have enough information or were put under pressure.

Royal College of Obstetricians and Gynaecologists guidance and guidance on consent from the Association of Anaesthetists of Great Britain and Northern Ireland state that special care must be taken when obtaining consent from women who are in labour, particularly if they are under the influence of narcotic analgesics (opiate-derived painkilling drugs).

If you can't give consent in an emergency, for example because you are unconscious, you can be treated to save your life or stop your condition getting much worse. In a situation like this, if there is time, the healthcare team should talk to your next of kin about any decisions.

It is very rare that you would be unable to give consent even if you did need emergency treatment during pregnancy or labour.

Even if healthcare professionals think your baby's life is at risk, they cannot perform procedures, such as assisted birth (forceps or ventouse), without your agreement.

If it feels like an emergency and you feel under pressure to make a decision it can be useful to ask the healthcare professional something like, 'Am I in immediate danger? Is my baby in immediate danger?' This allows you to have a conversation about what the actual risk is, and how urgently you need to make a decision.

Yes. You can refuse treatment even if your doctors or midwives think you are wrong.

If you can make decisions, you can say no to treatment for any reason. Your reason does not have to make sense to other people. You can say no to treatment even where it might lead to your death, or your baby's death.
You can say something like 'I don't want that treatment' or 'I do not consent to this treatment'.

If you need advice on refusing treatment you can contact us.

Yes. Even if you gave consent you can change your mind. This is called withdrawing consent.

You can do this at any time. If your healthcare professional suspects you may no longer want the treatment, they must stop as soon as possible. They should talk to you and only carry on if they are sure you consent.
For example, you can say 'Stop'. If you want some time to process what is happening you can say 'wait a minute, please'. You can move away, if you are able to. If you are in labour, you can ask for the healthcare professional to wait till your contraction has finished before they carry out a vaginal examination. It is always ok to say no.
Mental capacity means that you can understand the choice you need to make about treatment and can make a decision.

In law, everyone has mental capacity unless it can be shown that you do not. It is very rare to not have mental capacity.

The people caring for you cannot say you do not have capacity simply because you do not agree with them.

If you are 16 or 17 then the law presumes that you have the capacity to consent to medical treatment.

If you are 16 or 17 and you wish to decline care, then in rare and serious cases someone with parental responsibility or the Court could override your decision. This should only happen if declining care would be likely to lead to your death or severe permanent injury.

If you are under 16 then you can consent to treatment if your healthcare professionals believe that you fully understand what is involved. This is called having Gillick competence. Otherwise someone with parental responsibility can consent for you.

Labour can be tiring and hard work but it is very unlikely that giving birth will make it hard for you to give consent.

During your pregnancy you should be supported to think about what you might want during labour. You should be given plenty of time and opportunities to discuss decisions that might come up in your case.

If you are in labour your health professionals must take extra care to be sure you have consented to treatment. They must take even more care if you are given painkillers called narcotic analgesics. These are opioid drugs and can make you sleepy.

If you know you will find it hard to communicate during labour, talk to your healthcare professionals early.
For example, this could be because you use British Sign Language and need an interpreter. Or it could be because you are autistic and pain can make it very hard for you to speak or use your assistive technology.
Providing communication support is called a 'reasonable adjustment'. The Trust or Board must make sure that anyone who is disabled has equal access to all of its services. This applies throughout your pregnancy, labour and postnatal care. It includes making sure you can communicate and give informed consent when giving birth. This applies to written as well as spoken communication.

You are the expert in what you need in order to communicate and your healthcare professionals must listen to you.

Only you can give consent to your treatment or care.

You can ask a birth partner, including a doula, to support you during labour. You can ask them to communicate on your behalf to express the preferences you have made in your birth plan.

If something changes in your labour and you need to give consent to something that isn't covered in your birth plan, only you can make that decision.

Your birth partner or doula can support you in this situation. You can ask for some time to discuss the decision alone with them if you want. Or, for example, they can assist you by asking on your behalf for more information about any new risk the midwife raises, how urgent a treatment really is, and how important it is.
Some autistic people can find it very difficult to communicate during labour and to give or refuse consent. It can be hard for autistic people to show that they are in pain, and it can be hard for them to speak when in pain or experiencing sensory overload. If you are autistic, you can ask an advocate to support you from the start of your pregnancy. During labour, if your advocate recognises your personal signs that you are distressed they can ask the health professional to stop by saying, 'Stop', or 'I don't think they want you to continue'.
Yes. Before treating a baby, healthcare professionals must ask consent from a person with 'parental responsibility' for the baby.

In law, the mother always has parental responsibility for her baby. The father has parental responsibility if he meets certain criteria.

A trans man who has given birth will legally be described as the mother under current law. Non-binary birthing people are also described as mother at present.

If parents decline treatment for their baby, healthcare professionals should respect their decision.

No one should threaten parents with a referral to social services to make them consent to treatment for their baby.

A baby should only be referred to social services if health professionals think ('have reasonable belief') that the baby is at risk of significant harm.

In rare and serious cases, including if parents disagree about treatment or doctors feel that the parents' decision is not in their child's best interests, healthcare professionals may ask the High Court to decide. They can ask the High Court to declare that the treatment should be carried out, or not carried out, because it is in your baby's best interests.

Law and guidance

Everyone has the right to make decisions about their body for themselves. This is called the principle of autonomy.

The principle of autonomy is protected under Article 8 of the European Convention on Human Rights and common law of England and Wales, and common law in Scotland. You can read more on our factsheet Human Rights in Maternity Care.

The law says that pregnant women are entitled to make autonomous decisions in the same way as any other person. Even if healthcare professionals disagree with their decisions they must respect them.

The principle of autonomy creates a legal requirement to seek a person's consent whenever they are given any medical treatment.

The only exceptions are rare cases: when a person does not have the capacity to make their own decisions; or in an emergency when a person cannot consent because of their physical condition (for example when they are unconscious).

If a person's consent is not obtained, the medical treatment will be against the law. It will be negligent, and in England and Wales, it will also constitute the crime of battery, and a civil wrong of trespass to the person.

Failure to obtain consent also violates Article 8 of the European Convention. If the harm that occurs as a result is serious, it will breach Article 3 of the European Convention prohibiting inhuman and degrading treatment.
Consent includes knowing who is providing healthcare
In the case of Konovalova v Russia (2015), the European Court of Human Rights held that women's consent must be sought for all medical care provided during labour and this included consent for medical students to be present during a birth. As a result, any person who is providing maternity care should be clear about their status and explain if they are a student, so that the patient can decide whether they wish to receive care from them or to have them present.

The healthcare professional must give the person the information they need before seeking consent. The information should cover any material risks, any alternative treatments that are available, and the risks of doing nothing.

In the Supreme Court case, Montgomery v Lanarkshire Health Board (2015), the court stated that the test for whether a risk is a 'material' one is whether a reasonable patient would attach significance to the risk, or whether the doctor should be aware that the particular patient would attach significance to it. This means that there must be an honest conversation between doctor and patient and the assessment of risk must be sensitive to the individual's characteristics.

When thinking about how significant a risk is for a particular patient, statistics are only one factor. For example, the risk of complications for future pregnancies after a C-section might be statistically small, but it would be more significant for someone who wished to have multiple children than for someone who did not. Every person perceives risk differently.

Hospitals cannot only rely on printed leaflets or online material to provide relevant information; there must always be a personal discussion between the patient and the health professional ( Montgomery v Lanarkshire Health Board (2015)).

Leaflets and online material can form a useful starting point for an informed conversation. Health professionals must make sure that people have time and any support they need to understand the information, to make notes, and to think about the information. When someone finds spoken communication difficult, it is important to give support and to be flexible about their preferred means of communication, for example using a pain scale or assistive technology.

Giving misleading information about someone's medical condition or the proposed treatment, or not giving them relevant information, may mean that consent was not valid. The failure to provide appropriate information may also leave the healthcare professional open to a successful claim of negligence if the person suffers harm as a result of the treatment.

If the patient asks specific questions, a healthcare professional must give full, honest and objective answers. They should take the time that is needed to do this.

General Medical Council guidance on consent sets out how doctors should support people to make decisions about their care, including how consent should be recorded.

The Royal College of Obstetricians and Gynaecologists also provides advice on consent, and on specific procedures and the risks associated with those procedures, including caesarean section, operative vaginal delivery, and participating in research while in labour.

The National Institute for Health and Care Excellence (NICE), which makes guidelines for health and social care, has guidance on improving the experience of care for people using adult NHS services, which includes information about how healthcare professionals should communicate with patients and how to present information about risks and benefits, to enable them to make decisions about their care. NICE guidance is not law, but a hospital has to give good, clear reasons if it does not follow the guidance.

Consent does not need to be recorded in writing. It may be given verbally or with a gesture. Someone might move away from a healthcare professional, shake their head, or simply say, 'No'.

It is usual practice to sign a consent form for surgical procedures, but this does not reduce the need for a fully informed dialogue between the patient and their health professional ( Montgomery v Lanarkshire Health Board (2015)).

A signed consent form and/or medical notes are evidence of consent but do not prove it was obtained: they may be contradicted by other evidence that consent was not well-enough informed or freely given.

The GMC's guidance, Department of Health's reference guide and the Scottish guide on consent contain further information on the form consent should take.

The courts in England and Wales have upheld the rights of patients to make important medical decisions affecting their lives for themselves.

A mentally competent patient has an absolute right to decline medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own death.

A mentally competent pregnant person may decline treatment during pregnancy or labour even where that might lead to death or serious harm to them or their baby.

Royal College of Obstetricians and Gynaecologists guidance states that special care must be taken when obtaining consent from women who are in labour, particularly if they are under the influence of narcotic analgesics (opiate-derived painkilling drugs).

If someone has difficulty understanding spoken English, NHS England sets out how Trusts should obtain language support. This could include hiring a professional interpreter or translating written material. Everyone needs to be able to communicate fully and understand what consent they are being asked for.

The GMC guidance on consent says that doctors should use an interpreter or translation service.

If someone's illness or disability means that they need support to communicate, this is called reasonable adjustment. The right to reasonable adjustment is set out in the Equality Act 2010.

The principle of reasonable adjustment is that the Trust must make sure that everyone has equal access to all of its services. They must put in place the support that someone needs to understand the treatment they are being offered, and to communicate their consent. This could include large print information materials for someone who needs this, lighting that enables someone to lip read, or an advocate to support understanding and communication.

The NHS has been trialling Reasonable Adjustment Flags, a way for people's needs for extra support to be highlighted to healthcare professionals every time they use the health service.
About Birthrights
Birthrights factsheets give you information about your human rights when you are pregnant and giving birth.

Birthrights champions respectful care during pregnancy and childbirth by protecting human rights. We provide advice and information to women and birthing people, train doctors and midwives, and campaign to change maternity policy and systems.

We are a charity, independent of the government and the NHS.
Disclaimer: Our factsheets provide information about the law in the UK. The information is correct at the time of writing (May 2021). The law in this area may be subject to change. Birthrights cannot be held responsible if changes to the law outdate this publication. Birthrights accepts no responsibility for loss which may arise from reliance on information contained in this factsheet. Birthrights has provided links to third party websites where these may help provide relevant further information. Birthrights takes no responsibility for the contents of linked websites and links should not be taken as an endorsement.
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Consent means saying yes Consent means saying yes. You have the right to make your own decisions about your body, just as you do at any other time. It is against the law to give you medical treatment unless you agree to it. It is also against the law for treatment to be given to ...

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Choosing where to have your baby (1st baby)

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Choosing where to have your baby (1st baby)

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NHS (May 2018)

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NCT

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Hormones, labour and birth: an introduction

You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth. These hormones are:

oxytocin (the love hormone)

beta-endorphins (the hormones of pleasure and transcendence)

epinephrine and norepinephrine (the hormones of excitement)

prolactin (the mothering hormone).

(Buckley, 2002)

Here's what impact all four will have on you...

Oxytocin or the love hormone

Oxytocin is the love hormone, which is why it's released during sex, orgasm, birth and breastfeeding (Odent, 1999; Buckley, 2002).

Oxytocin will make you feel more affectionate and selfless, and its main function in labour is to bring on contractions (Dawood et al, 1978). You'll get a surge of oxytocin in the final stage, so if you're having a vaginal birth it will help you along with pushing.

Oxytocin reduces stress, calms you down and helps with pain during labour (Buckley, 2015). Impressively, your baby will also produce oxytocin before and during labour (Chard et al, 1971).

Oxytocin hangs around after birth too, helping you feel more relaxed, well-nourished and bonded with your baby (Buckley 2002, Buckley 2015). It helps with the let-down reflex during breastfeeding and protects you against postpartum haemorrhage (Buckley, 2002).

Beta-endorphins or the pleasure hormones

Endorphins are naturally occurring opiates, similar to morphine and heroin. Like oxytocin, they mostly appear during sex, pregnancy, birth and breastfeeding. Beta-endorphins reduce pain and suppress the immune system, which is important so that it doesn't act 'against' your baby (Buckley, 2002, 2015).

If you're stressed during labour, that can make you release excessive beta-endorphins, which may inhibit oxytocin and slow things down (Buckley 2015). That's why keeping things as calm as possible is a great thing in labour.

Beta-endorphin also helps with the release of prolactin during labour, preparing your breasts for feeding (Rivier et al, 1976).

And one more thing: it helps in the final phase of your baby's developing lungs too (Buckley 2015).

Epinephrine and norepinephrine or fight or flight hormones

You might have heard these two referred to as fight-or-flight hormones but their proper names are epinephrine and norepinephrine (adrenaline and noradrenaline). They are produced during stresses like fright, anxiety, hunger or cold and also when you're excited (Buckley 2015).

You're likely to get a high level of these hormones if you don't feel private, calm, safe and undisturbed and they can then inhibit oxytocin (Buckley 2015). Yet in the late-labour stage if you perceive danger or stress, they may paradoxically stimulate contractions so you give birth more quickly (Buckley 2015).

A rise in epinephrine when you're in the later stages of labour increases your levels of prostaglandin and cortisol to help with contractions. This will make you feel a sudden rush of energy and will cause several strong contractions and will help you push (Buckley, 2002, 2015).

These hormones help your baby too by protecting them against a lack of oxygen (Buckley, 2002). Your baby will have high levels of these hormones during birth but they'll drop quickly once you sooth them afterwards (Lagercrantz and Bistoletti 1977; Buckley, 2002).

Prolactin or the mothering hormone

Prolactin is the mothering hormone. And it's the major hormone for breastfeeding.

Prolactin starts to increase during pregnancy and peaks at birth (Buckley, 2002). Your baby produces prolactin in the womb too (Daniels and Martin, 1994).

Hormones and your feelings after birth

Lots of women get the baby blues during the first week after birth of her baby days (NHS Choices, 2018). You might feel down or depressed, emotional or irritated and likely to burst into tears at any second.

Don't despair though: these symptoms are totally normal. They're due to the sudden hormonal and chemical changes that happen after you give birth.

If you feel like you are suffering from something more extreme and it isn't going away though, talk to your GP or midwife. You might be suffering from postnatal depression and should get some support or help right away.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Buckley SJ. (2015) Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women and Families. Available from: http://www.nationalpartnership.org/research-library/maternal-health/hor... [Accessed 25th April 2018]

Buckley SJ. (2002) Ecstatic birth: The hormonal blueprint of labor. Available from: http://www.dancingstarbirth.ca/Handouts/Ecstatic_Birth.pdf [Accessed 25th April 2018]

Chard T, Hudson CN, Edwards CR, Boyd NR. (1971)Release of oxytocin and vasopressin by the human fetus during labour. Nature. 234:352-354. Available from: https://www.ncbi.nlm.nih.gov/pubmed/4944487 [Accessed 25th April 2018]

Daniels G, Martin J. (1994) Neuroendocrine regulation and diseases of the anterior pituitary and hypothalamus, In Harrison's Principles of Internal Medicine, 13th edition. New York: McGraw- Hill. [Accessed 25th April 2018]

Dawood MY, Raghavan KS, Pociask C, Fuchs F. (1978) Oxytocin in human pregnancy and partrurition. Obstetrics and Gynecology. 1978; (51):138-143. Available from: https://www.ncbi.nlm.nih.gov/pubmed/622223 [Accessed 25th April 2018]
Lagercrantz H and Bistoletti H. (1977) Catecholamine release in the newborn infant at birth. Pediatric Research. 8:889-893. Available from: https://www.ncbi.nlm.nih.gov/pubmed/887309 [Accessed 25th April 2018]

NHS Choices. (2018) Feeling depressed after childbirth. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-afte... [Accessed 25th April 2018]

Odent M. (1999) The Scientification of Love. London. Free Association Press.

Rivier C, Vale W, Ling N, Brown M, Guillemin R.(1976) Stimulation in vivo of the secretion of prolactin and growth hormone by beta-endorphin. Endocrinology. 100:238-241. Available from: https://www.ncbi.nlm.nih.gov/pubmed/187406 [Accessed 25th April 2018]

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Hormones in labour: oxytocin and the others - how they work

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You know your hormones are going to be working hard at this time but you might not know exactly what they're doing. You'll in fact have four major hormonal systems active when you're in labour and giving birth.

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Understanding how risk is discussed in healthcare

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Understanding how risk is discussed in healthcare

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Royal College of Obstetricians and Gynaecologists (2015)

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The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

Risk is the chance that any activity or action could happen and harm you. Almost everything we do has an associated risk. Living is a risky business. People will generally take risks if they feel that there is an advantage or benefit. We need to look at risks and benefits together. Normally the benefits of an action should outweigh the risks. There is no such thing as a zero risk. How you view risk depends to a large extent on your own circumstances and 'comfort zone'.

This information will help you understand how your healthcare professionals will discuss risk with you in relation to your health care and medical treatment.

This information covers:

why you need to know about risk

how risk is discussed

how risk is presented in everyday life

the best ways for risk to be explained

Understanding risk

Sometimes research evidence may not be clear about a particular risk or benefit. This is why you may receive different information from different healthcare professionals. It may be because of the situation in which your healthcare professional is working, their own personal experience, your personal situation or because the true risk is not known. Uncertainty exists.

Understanding risk can be difficult but it is helpful when you work in partnership with your healthcare professional.

Reference

Calman KC, Royston G. Personal paper: Risk language and dialects. British Medical Journal 1997;315:939-42.

When you are considering having a procedure, intervention or screening test for yourself or someone else, you need to know about the benefits and risks or any uncertainties to help you to make an informed decision.

How you view a risk depends on one or more of the following:

the chance of the event occurring (frequency)

the chance of a condition being detected by a screening test (detection rate)

the benefits of the treatment or screening

how much harm may be caused:

if it is life-threatening

if it is short-term (temporary) or long-term (permanent)

how much you feel in control of the decision

how much you trust the person discussing the risk with you

whether you feel you understand the situation sufficiently.

Some of these factors will be more important to you than others.

Healthcare professionals use research evidence to describe the chance of an event occurring in the context of an entire population. So your healthcare professional can tell you one woman in nine (1 in 9) will develop breast cancer. What they cannot tell you is whether the 'one' woman who develops breast cancer will be you.

If you have a screening test for a particular condition or disease, the results tell you if you are at 'high risk' or 'low risk' for that condition or disease. For example, if you are pregnant you will be routinely offered a screening test for Down syndrome. The results of this test will show if your unborn baby has a 'high risk' or a 'low risk' of having Down syndrome. A high-risk result does not mean that your unborn baby definitely has Down syndrome. It means that the risk of Down syndrome is more than 1 in 250 (of 250 pregnant women, more than one woman has an unborn baby with Down syndrome). In this situation, you would be offered a further test to find out if your unborn baby is one of the babies with Down syndrome.

Even if you have a low-risk result, there is a chance that your unborn baby may have Down syndrome but it may be helpful to know that the chance is small.

Risk can be given as numbers or words, or both. This table below shows how risk should be described in healthcare:

People's views of the descriptions of 'very rare' or 'common' regarding harm or satisfaction vary greatly concerning health care. Your concerns, anxieties and fears about the present and the future are very personal and may affect how you view risk. Some people find it is more useful to discuss risk using numbers or pictures rather than words.

Health risks are talked about every day - sometimes well, sometimes poorly.

Often it can be difficult to sort out the real facts of a matter. Take, for example, the confusion over the 1995 'pill scare'. Scientists reported that some oral contraceptives doubled the risk of thromboembolism (a blood clot) compared with other oral contraceptives. To say that something 'doubles' sounds a huge amount. What the initial report did not mention, however, was that the risks were only 1 in 6000 to start with - which is 'rare'. The new risk - 1 in 3000 (or 2 in 6000) - is still rare. In addition, the increased risk of death was only about one person in a million. The risk had not been put into context and a result there was panic in the media and among the public.

Sometimes percentages are used when the overall numbers are very small indeed. It is very important that the facts are explained in a meaningful way.

Good communication between you and your healthcare professional promotes a trusting relationship and brings greater satisfaction to you both. It also helps you to take more responsibility for decisions about your own health care.

When explaining risk healthcare professionals should:

involve you fully

give you the opportunity to have someone with you (such as a friend, partner or relative)

know and understand your circumstances and how this could affect you personally

describe the risk in different ways; for example, 'your risk of breast cancer is 1 in 9 or your chance of never getting breast cancer is 8 in 9'

give you correct and up-to-date information

give you information that is relevant to you

be honest, frank and open

speak clearly

have empathy

listen to your concerns

give you an opportunity to ask questions

give you time

provide sources of information such as leaflets or websites

check that you have fully understood

. . . and on your part, you should:

say if you don't understand

ask if you want information presented in a different way

say if you need more time.

Your healthcare professional may explain the information in a number of different ways, such as pictures, graphs and other tools to help you make a decision. These help to ensure a better understanding.

Sources and acknowledgements

This information has been developed by the RCOG Patient Information Committee. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) Clinical Governance Advice No. 7, Presenting Information on Risk (December 2008). The clinical governance advice contains a full list of the sources of evidence we have used. You can find this online here.

This leaflet was reviewed before publication by women attending clinics in in Newcastle-upon-Tyne and Surrey and by the RCOG Women's Network.

This patient information leaflet is based on the RCOG's Clinical Governance Advice Presenting Information on Risk, which contains a full list of the sources of evidence used to produce this guidance.

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Understanding how risk is discussed in health care

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The information here aims to help you better understand your health and your options for treatment and care. Your healthcare team is there to support you in making decisions that are right for you. They can help by discussing your situation with you and answering your questions.

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Why it's a good idea to have a birth plan

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Why it's a good idea to have a birth plan

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Birthtalk.org (2012)

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NCT (April 2018)

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Having a birth partner present during labour helps to improve birth experiences. So it's important to think about who you would like to support you during this exciting time and plan ahead. Read on to find out more about birth partners and the important role they have in supporting women in labour.

What is a birth partner?

A birth partner is someone like your partner who is present during labour and the birth of your baby to help support you with what you need at the time. They might provide encouraging words, sips of water or maybe a snack, or even just a quiet, comforting presence. Birth partners may also play an important role in helping you prepare for giving birth by attending parenting classes and helping you with your birth plan.

You can read our top ten tips for birth partners for more practical ideas for how they can help.

Who can be a birth partner?

Anyone who you are comfortable with being at your labour and your baby's birth can be a birth partner. It could be your partner, a close friend, or a family member.

You might also wish to consider having a paid professional present. This could be an independent midwife or a doula.

What is a birth doula?

A doula is someone who provides physical and emotional support to you (and your partner) during labour and delivery. They don't do anything medical but are a continuous, reassuring presence. They are there to listen to you, support your decisions, help you understand what is happening and help you have the kind of birth you want. Most (but not all) doulas are mothers themselves and may have done additional training.

NCT has a service provided by specially trained doulas, called NCT Doula, which provides one-to-one support for parents. They support you from late pregnancy, through labour, delivery, and into the first weeks with your new baby.

Why do I need a birth partner?

Having a birth partner or partners will give you continuous labour and birth support. Just having a friendly and familiar face will help to put you at ease. If you give birth in a hospital, it is likely that the midwives will be looking after more than one labouring woman at a time. They also need to manage technology, keep records and may begin or end work shifts in the middle of a women's labour.

Research has shown that having a supportive birthing partner with you continuously through labour can help give you an added sense of control, comfort and competence. This in turn will help you have a better birth experience and decrease your chances of experiencing complications or having a medical intervention like a caesarean (Hodnett et al, 2013).

How do I choose my birth partner?

You can choose who you would like to be present at your baby's birth. Some women would like their partners to be present, while others prefer their mum, an independent midwife or doula, or a close friend or another family member. Read more about how to choose your birth partner in our article.

How many birth partners can I have?

It depends on where you choose to give birth and what you want. For example, some women ask a family member as well as their partner to be there. Some hospitals and birth centres may restrict the number of birth partners you can have so you'll need to check this with your midwife (Tommy's, 2018).

Having more than one birth partner can help because it can take the pressure off a bit. It can also come in handy if one birth partner needs to take a break, so you still have someone with you. Find out more in our article on choosing your birth partner.

What is the role of a birth partner?

The main role of a birth partner is to support and encourage you during labour and birth. In early labour they can provide you with company and chat. As labour progresses, they can help to keep you calm and comfortable and offer you support by:

providing emotional support like encouragement, praise, reassurance and listening to you

giving you physical support like rubbing your back, wiping a cool flannel on your face or helping you change positions and get more comfortable

providing you with practical support like getting you a drink or making phone calls to keep relatives updated.

(Northern Lincolnshire and Goole, NHS 2015; Which? Birth Choice, 2018)

What is it really like to be a birth partner?

For most birth partners, being there to see a baby being born is a moving experience. Many birth partners say it is one of the most memorable moments of their life. For some it can also be daunting and nerve wracking. Read our article about what it's really like to support a woman during labour.

Plan ahead

The most important thing is to read up on what to expect in labour and decide on the right birth companions and support for you. Think about what type of labour you would like, who you would like to be with you and how you would like them to support you. You'll also want to discuss it with them in advance.

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How birth partners can support labour | Labour & birth articles & support | NCT

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Having a birth partner or doula can help a woman to feel more in control and better supported during labour. Find out about more about the role of a birth partner.

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NICE guidance (Nov 2021)

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Overview | Inducing labour | Guidance | NICE

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This guideline covers the circumstances for inducing labour, methods of induction, assessment, monitoring, pain relief and managing complications. It aims to improve advice and care for pregnant women who are thinking about or having induction of labour

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HHFT (September 2020)

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Choices when pregnancy reaches 41 weeks 

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Choices when pregnancy reaches 41 weeks 

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NHS &  National Institute for Health Research (July 2016)

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Five questions to ask if you're offered induction of labour

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Five questions to ask if you're offered induction of labour

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Sara Wickham June 2022

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What are the best questions to ask if you're offered induction of labour?

This is something I get asked a lot. So I have put together this guide to the five best questions that you can ask in order to get more information and make the decisions that are right for you.

I'm also going to tell you what you can learn from the answers you are given.

In case we've not met before, my name is Sara. I'm a midwife, speaker, researcher and the author of two books about induction of labour. They are In Your Own Time and Inducing Labour: making informed decisions. I've also written a book to help women and families make birth decisions. That's called What's Right For Me?

Here's the important thing. I'm not here to tell you whether to have your labour induced or not. That's not up to me. (Or your midwife, obstetrician, childbirth educator, doula or hypnobirthing teacher, but we'll come back to that.) Your decision won't affect me or any of those people. And, as I am very fond of saying, one size doesn't fit all. My work is about trying to help you to understand and navigate the evidence so you can make the decisions that are right for you.

Let's start with what I think is the first question anyone should ask if induction is mentioned.

Question 1: Why are you suggesting this? / What's the indication?

The first thing you need is a clear and specific explanation of why you're being offered induction of labour. So "why" is the first question to ask.

Midwifery and medical professionals call this "the indication." Asking "what's the indication?" will help you find out whether or not there is a clear, single indication. But you don't have to use the jargon. You could also ask, "Why are you suggesting this?" Or, "Can you tell me exactly why you're offering me induction?"

You might have to ask this - and the other questions - more than once. Don't be afraid to do that. It's your body and your baby, and the decisions you make can affect you and your baby's health and you family for a long time. So unless you're in one of those rare situations where it's really an emergency, it's really okay to take time to think about them.

And one tip is that, if it's truly an emergency, you're not likely to be offered an induction. Induced labour often takes three days to get going. If there's a genuine emergency, you'll be offered a caesarean, which is much faster. So if someone offers you an induction and says it's an emergency, you might want to ask some questions about that.

What can you learn from the answer?

There are three common answers to questions about why induction is being offered.

"You or your baby have a medical problem."

The answer you get may be very clear and specific and mention an actual medical problem.

For instance, you might be told, "because you have pre-eclampsia." Or, "because your baby has a heart condition and we need him to be born so we can do surgery."

In these situations, it's still your decision, of course. And yes, there's a difference between having symptoms of pre-eclampsia and being close to developing eclampsia. So you might want to explore what you're being told in a bit more depth. You'll still want to ask the remainder of the questions below, and you can then decide whether or not the benefits of induction outweigh the downsides for you and your family. But where there's a clear and specific reason that involves an actual medical condition, it's more likely that induction is genuinely warranted.

This is a useful thing to know. Because there's an important difference between being offered induction because you or your baby actually HAS a specific named medical condition, and being offered induction because you or your baby is thought to be "at risk" of something. It's important to determine which is the case for you.

You might be told that you're being offered induction because you or your baby are "at higher risk." When you ask what that means, you discover that it's because you are for example over a certain age, larger than average, or you conceived by IVF.

None of those things are an actual medical condition. So let's look next at what you might want to consider if you're told you're being offered induction because you have one or more risk factors.

"You have a risk factor."

The second possible answer is that you are told something like this:

"We offer induction to everyone who is 41 weeks pregnant."

"Your BMI is over 35."

"We offer induction to everyone who has a suspected big baby."

"Induction is best for women who conceived by IVF or ARTs."

That list isn't exhaustive; they are just a few examples.

What this kind of answer tells you is that the offer isn't tailored to your specific, individual situation. You're being offered induction because you fall into one or more categories. In many countries, induction is routinely offered on a population basis to anyone who ticks a box or has a 'risk factor.'

You might still want induction in these circumstances, but it's important to know that having a risk factor is different to having an actual medical condition. Having an actual, diagnosed medical condition right now is different from being in a group that might be at greater risk of developing a problem. Most of the time, only a small number of those in the group will develop a problem, whereas someone with a medical condition definitely has that condition.

Often, the actual chance of women who are told they are "at risk" having a poor outcome is very low. More on what to ask about the numbers below. In many cases, there's still a very high chance of everything being just fine. And remember that induction has downsides too and life doesn't come with a "no risk" option.

This is where you really need to look at the evidence and weigh things up. Sometimes, induction is offered to women with risk factors in the hope of saving a very small number of babies. But there's not always clear evidence that it does save babies. And hundreds or thousands of women and babies need to have induction in the hope of saving one. Some of them will end up with other problems as a result of the induction and associated interventions, and so it's a question of weighing up the pros and cons. Often, there isn't good evidence to support induction for risk factors alone. There are some articles on this on our induction information hub and loads more on the evidence in In Your Own Time. And there's more on how to ask about the actual numbers below.

"Mumble, waffle, jargon, jargon."

The third common answer to this question is a reply that is unclear, provides little information or is full of jargon. Someone may list several potential problems or risk factors in an unspecific way that leaves you wondering what they just said. Don't let that put you off asking more questions. A garbled, unclear, or 'stun you with science' response may mean that the person you're speaking with is not really keen on you making your own decision. It might mean that there isn't a clear indication. If someone has to add three risk factors together to justify their offer but can't provide you with robust evidence for any of them, be wary.

It might be that the person offering induction may be afraid of physiological labour, or of waiting for women to birth in their own time. (It's more common than you might think.) They may genuinely think this is 'for the best', or just prefer to control when labour happens.

If you are given a list of complications or risk factors, ask lots of questions about what these complications are. Ask the questions below as well. There's more about this in my blog post on induction for gestational diabetes. Look at the section in that blog post called "Risks and recommendations." Even if you've not been told you have gestational diabetes, the principles are the same.

Don't be impressed by jargon. If an intelligent person has a justifiable suggestion, they should be able to explain and discuss it with you in a reasonable manner. If that's not happening, be alert.

This brings me to my next tip.

Question 2: What's the evidence?

Once you've discovered exactly why induction is being recommended in your situation, ask what the evidence says. This is another of the key questions to ask if you're offered induction. Ask if there is evidence of benefit of induction. Often there is not. And, if someone tells you that there is evidence of benefit, ask them to provide you with the evidence or a reference, so that you can look at it for yourself.

One thing that's important to know is that not all induction studies are good studies. Some were poorly conducted and/or were biased in their approach. This is especially true of some of those which claim to show that induction reduces the chance of caesarean section. Some studies are now quite old. It's possible the participants weren't similar to you. For instance they might not have given birth in the setting/country that you're in. This kind of evidence may not necessarily apply to you.

This is a complex area and I can't give all the detail here (which is one reason I write books for those who want more in depth information). But some of the more controversial studies to listen out for include The Canadian Post-Term Trial, the ARRIVE Trial, and the SWEPIS study. The last one is sometimes described as a Swedish study which was stopped because some babies died. Yes, they did, which is very sad. But that doesn't mean they would have been saved by induction, or that a lack of induction was the problem. The media headlines and those who quote this study have been criticised by other researchers. That's because there were some issues with the trial. Data from a half-finished study isn't robust enough to let us draw conclusions and make recommendations. Again, if you'd like more detail, have a look at my other induction blog posts or grab one of my books.

What can you tell from someone's reply to this question?

Well, you're looking for a reply that is clear, honest and that acknowledges that no research study is perfect. If you feel that the person is trying to convince you that they are absolutely right and there's no room for debate, be alert. If they try to stun you with science and numbers, they may not really be wanting you to make your own decisions. Good practitioners will be happy to share the evidence with you and discuss the pros and cons in an open way that focuses on what's right for you.

Question 3: What's the absolute risk?

If you are told that there is a specific reason for induction, especially if that is a risk factor, ask for some numbers.

Some professionals will tell you the relative risk of something happening but not the absolute risk. So they might say, "your baby is twice as likely to die if you do X rather than Y." But what they don't tell you is that the risk of Y is one in 4000 and the risk of X is one in 2000. In other words, the unwanted outcome is very, very unlikely no matter what you do.

And, as we'll get to in the next tip, intervention carries downsides as well as advantages.

It's always a good idea to ask for the absolute risk of a problem occurring, no matter what health decision you're making. As with the last tip, you may also want to ask for the evidence or a reference so you can look at it yourself.

Also as with the last tip, you should be able to tell a lot from their response. All of the things I've mentioned about this above apply here as well. How open and honest are they in their response? Is there acknowledgement that there's not always one clear 'correct' way that's right for everyone?

Question 4: What are the downsides?

You should also ask about the downsides of induction.

I recommend asking this question even if you feel you already have this information. If you've been to my website before, you may already know that induction has downsides. ( If not, there's lots more info on that here. I recommend that families ask this question even if they already know what the downsides are.

That's because asking this question is an excellent way of finding out if the person you are speaking to is being open and transparent about the pros and cons of the different options. Anyone who is being respectful should honestly and openly tell you the things in this article. They should also mention the negative consequences of induction for you and your baby.

If they don't tell you these things, or they gloss over them, treat it as a red flag. You need the full picture. And you deserve caregivers who will give you that.

Question 5: How, when, where, what and who?

Find out about the process of induction, the pros and cons, the evidence for the most common reasons and the information you need to decide if it's right for you.

Don't be afraid to keep asking until you have enough information. If you want to be prepared before you have this conversation, there is also lots of info on the practical reality of induction in Inducing Labour: making informed decisions.

Many women are dissatisfied with their experience of induction. This is one of the key issues that comes up in the studies that ask women about their experience. One of the main reasons for this is that they had not been given adequate information about what would happen. They were not told, for instance, that induction can sometimes take three or four days to get going. They were not told that the early contractions can be quite painful, even though they may not be doing much. Women aren't always told that their partner, family, friends or doula can't be with them except during visiting times. These hours are quite restricted in some places. In others, they aren't. The induction experience varies a lot; it's a postcode lottery.

So ask as many questions as you need to in order to get a sense of what it would be like in your area. Then, you will be much better placed to weigh this up with all the other information you've gathered and decide whether induction is right for you and your baby.

So those are my five best questions to ask if you're offered induction. I hope that these questions will help you consider and explore your options. There's lots more induction information on this website. Make a cup of tea and have a look around!

If you'd like more in-depth information or to learn more about the evidence, you might enjoy In Your Own Time and/or Inducing Labour: making informed decisions. My book What's Right For Me? also contains lots of information about birth-related decision making.

Books to help you become informed and make the decisions that are right for you...

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Five questions to ask if you're offered induction of labour - Dr Sara Wickham

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What are the best questions to ask if you're offered induction of labour? Here are 5 great questions and what you'll learn from the answers.

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Ten things I wish every woman knew about the induction of labour

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Ten things I wish every woman knew about the induction of labour

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Sara Wickham (May 2018)

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NCT (September 2018)

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Knowing what to expect and understanding why your doctor or midwife might recommend an assisted birth can help you feel more confident about the process. It's especially good to know about this just in case you have a long, challenging labour, or if concerns about the baby crop up. Read on to find out more.

What is an assisted birth?

An assisted or instrumental birth is when ventouse or forceps are used in the later stages of labour to help a baby to be born.

"About one in eight babies in the UK are born with the help of these instruments." (RCOG, 2012, 2016; NHS, 2017)

You're more likely to need an assisted birth if you're giving birth vaginally for the first time.

What are ventouse and forceps?

A ventouse is a cup-shaped suction device that can be attached to your baby's head to help them to be born. You might have heard it called a vacuum delivery (NHS, 2017).

Forceps are smooth, curved metal instruments that look like large tongs. They're placed around the baby's head to help pull the baby out.

Why might I need help with the birth of my baby?

Sometimes, when the second stage of labour is very long, an assisted birth is suggested because:

the baby needs a little help to move out of the birth canal, particularly if they are lying in the back-to-back position

there are concerns about you or your baby

you are exhausted

you are unable to push, perhaps after an epidural, or because you have a condition that prevents you from doing so.

(RCOG, 2012; NICE, 2014; NHS, 2017)

What are my other options?

If your doctor thinks an assisted birth is possible but could be difficult, you would be moved to an operating theatre in case you need a caesarean section (NICE, 2014). Usually, you'd be offered an assisted birth first because if it works this can help your baby out quicker than a caesarean. This is important if the baby is in trouble.

As with any medical intervention being offered, you can say 'no' to an assisted birth. Your doctor or midwife should first discuss why you need an assisted birth and their choice of instrument and gain your consent (RCOG, 2012). A caesarean birth involves major surgery, which carries risks and takes longer.

If the ventouse or forceps do not help your baby out, you will need a caesarean.

What happens during a forceps or ventouse assisted birth?

The midwife or obstetrician will examine you. If there are concerns about you or your baby's health, you might need an emergency caesarean and be moved to an operating theatre. This way, if the forceps or ventouse is unsuccessful, a caesarean birth can happen soon after. For example, if the baby's head needs to be turned, forceps or ventouse might not help so easily.

If you haven't already had an epidural, you will be offered one, or a single spinal injection or local anaesthetic to numb the area around the vagina (RCOG, 2012). You'll lay on your back and have your feet in stirrups. Your bladder will be emptied using a catheter.

You might have a cut (episiotomy) made at this point to make your vaginal opening bigger (RCOG, 2012; NICE, 2014). This isn't routine but might be necessary (NHS, 2017). You're less likely to experience vaginal tearing with ventouse than with forceps (RCOG, 2012).

In a ventouse delivery, the obstetrician or specially-trained midwife will attach a suction cup to your baby's head. They'll then gently pull when you have a contraction, to help your baby out. They might need to pull more than once (RCOG, 2012).

A ventouse is not suitable if you are less than 34 weeks pregnant. This is because the baby's head is softer thus increasing the risk of your baby getting bruised, or having a brain haemorrhage or jaundice (RCOG, 2012).

If you have a forceps delivery, the doctor or midwife would gently place them around your baby's head. Then on the next contraction you will be asked to push as your baby is carefully pulled. You'd normally need an episiotomy first (RCOG, 2012).

Ventouse or forceps delivery?

Ventouse and forceps are both safe and effective. If you do need assistance, your doctor would choose the most suitable instrument for you, your baby and your situation. Forceps are more successful in assisting the birth than ventouse. Yet ventouse is less likely to cause vaginal tearing (NHS, 2017).

Can I avoid an assisted birth?

An assisted birth can't always be avoided but you can reduce the risk. Here's how:

If your pregnancy has been straightforward, try planning to give birth in a birth centre or at home. That means you are less likely to need forceps, ventouse or any other interventions.

Continuous support from a birth partner other than your midwife can make a positive difference.

Remain upright or on your sides and mobile to give you and your baby the best chance of a spontaneous birth.

Avoid an epidural if possible, or if you do have an epidural, wait for a while after your cervix is fully dilated before beginning to push.

(Hodnett et al, 2010; Hollowell et al, 2011; RCOG, 2012; Hodnett et al, 2013; NCCWCH, 2014)

What can birth partners do?

It might be helpful to think about the support you can give your partner if she need forceps or ventouse assistance. This could mean offering reassurance if this is a change to your birth plan, or simply holding her hand during the birth (RCM, 2012).

Some partners have said they found it difficult watching forceps or ventouse being used. So consider where you might want to stand during the birth.

It's also a good idea to discuss birth scenarios in advance so you're clear on whether your partner would prefer you to stay with her or go with the baby if needed. For example, you could provide skin-to-skin care for the baby if your partner isn't able to.

What are the effects of a forceps or ventouse delivery on babies?

Some parents-to-be worry their baby may be harmed during an assisted birth. But any effects are likely to be short term, resolving within 24 to 48 hours (RCOG, 2012).

Forceps can cause bruising, marks or cuts on a baby's head, while a ventouse may temporarily affect the shape of a baby's head (RCOG, 2012). The suction cup used for ventouse delivery might also mark a baby's head or cause a bruise that disappears in time (NHS, 2017). Small cuts on a baby's face and head may occur but generally fade quickly (RCOG, 2012).

If you are worried about any after-effects, talk to your health visitor or GP.

How will I be affected?

It's normal to feel bruised and sore after birth, particularly if you had an assisted birth.

Help and support is available, so do seek medical advice if you experience any difficulties or complications. Your midwife or GP can talk through your options with you.

As you're more likely to have an episiotomy during an assisted birth, stitches and swelling or tearing may make going to the toilet painful (RCOG, 2015). You'll probably need to up your intake of fibre (RCOG, 2015). You could also take a stool softener to make it easier to open your bowels. See our article about episiotomy care and recovery for more details.

Four in 100 women who have a ventouse birth will have a third or fourth degree tear (into the tissue surrounding the anus). That compares with eight to 12 women in 100 who have a forceps birth will have a third or fourth degree tear (RCOG, 2012).

Third or fourth degree tears would need to be repaired in an operating theatre and it is normal to feel pain for two or three weeks afterwards (RCOG, 2015). You'll be offered pain-relief and a course of antibiotics after the operation, and will need to keep the area clean (RCOG, 2015). See our article about perineal tears for more details.

Most women will recover from an assisted birth within a few weeks. But some might experience complications, such as severe vaginal tearing, blood clots and urinary or anal incontinence (RCOG, 2012). If you have any medical concerns talk to your midwife, health visitor or GP.

How will I feel?

Sometimes, an assisted birth can leave new parents feeling as if the situation was taken out of their hands. Difficult birth experiences like an assisted birth can affect women's psychological health with around one third of women in the western world evaluating their childbirth experience as traumatic (Ayers et al, 2006).

If this is how you feel, it can help to chat to the doctor or midwife before you leave hospital. You could ask about what happened and why it was necessary (RCOG, 2012).

Some women and their partners might also want to talk about the emotional impact after they have gone home (RCOG, 2012). If you did an NCT antenatal course, you could get in touch with your antenatal teacher to talk this through.

Most hospitals have a 'birth reflections' service. This service gives you the chance to discuss the events with a midwife and resolve unanswered questions (Ayers et al, 2006).

Will I need an assisted birth if I have another baby?

It's unlikely you will need an assisted birth with subsequent babies. Most women (80%) who have an assisted vaginal birth give birth spontaneously next time around (RCOG, 2012).

This page was last reviewed in September 2018.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

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Assisted birth: ventouse or forceps delivery | Labour & birth, Different types of birth articles & support | NCT

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Some births need a little help. Here we explain what an assisted birth is, why ventouse or forceps might be needed, what happens and how you might feel.

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NCT (August 2017)

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Breech babies: what you need to know | Labour & birth, Different types of birth articles & support | NCT

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Wondering what happens if your baby’s facing bottom up during pregnancy? Here are some of your questions answered.

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NHS (November 2020)

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Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be:

bottom first or feet first (breech position)

lying sideways (transverse position)

Bottom first or feet first (breech baby)

If your baby is lying bottom or feet first, they are in the breech position. If they're still breech at around 36 weeks' gestation, the obstetrician and midwife will discuss your options for a safe delivery.

Turning a breech baby

If your baby is in a breech position at 36 weeks, you'll usually be offered an external cephalic version (ECV). This is when a healthcare professional, such as an obstetrician, tries to turn the baby into a head-down position by applying pressure on your abdomen. It's a safe procedure, although it can be a bit uncomfortable. Around 50% of breech babies can be turned using ECV, allowing a vaginal birth.

Giving birth to a breech baby

If an ECV does not work, you'll need to discuss your options for a vaginal birth or caesarean section with your midwife and obstetrician.

If you plan a caesarean and then go into labour before the operation, your obstetrician will assess whether it's safe to proceed with the caesarean delivery. If the baby is close to being born, it may be safer for you to have a vaginal breech birth.

The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information on what to expect if your baby is still breech at the end of pregnancy.

The RCOG advises against a vaginal breech delivery if:

your baby's feet are below its bottom - known as a "footling breech"

your baby is larger or smaller than average - your healthcare team will discuss this with you

your baby is in a certain position - for example, their neck is very tilted back, which can make delivery of the head more difficult

you have a low-lying placenta (placenta praevia)

you have pre-eclampsia

Lying sideways (transverse baby)

If your baby is lying sideways across the womb, they are in the transverse position. Although many babies lie sideways early on in pregnancy, most turn themselves into the head-down position by the final trimester.

Giving birth to a transverse baby

Depending on how many weeks pregnant you are when your baby is in a transverse position, you may be admitted to hospital. This is because of the very small risk of the umbilical cord coming out of your womb before your baby is born (cord prolapse). If this happens, it's a medical emergency and the baby must be delivered very quickly.

Sometimes, it's possible to manually turn the baby to a head-down position, and you may be offered this.

But, if your baby is still in the transverse position when you approach your due date or by the time labour begins, you'll most likely be advised to have a caesarean section.

Video: My baby is breech. What help will I get?

In this video, a midwife describes what a breech position is and what can be done if your baby is breech.

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Babies often twist and turn during pregnancy, but most will have moved into the head-down (also known as head-first) position by the time labour begins. However, that does not always happen, and a baby may be: bottom first or feet first (breech position) lying sideways (transverse position) If your baby is lying bottom or feet first, they are in the breech position.

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Royal College of Obstetricians and Gynaecologists (July 2017)

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ECV involves applying gentle but firm pressure on your abdomen to help your baby turn in the uterus to lie head-first.

Relaxing the muscle of your uterus with medication has been shown to improve the chances of turning your baby. This medication is given by injection before the ECV and is safe for both you and your baby. It may make you feel flushed and you may become aware of your heart beating faster than usual but this will only be for a short time.

Before the ECV you will have an ultrasound scan to confirm your baby is breech, and your pulse and blood pressure will be checked. After the ECV, the ultrasound scan will be repeated to see whether your baby has turned. Your baby's heart rate will also be monitored before and after the procedure. You will be advised to contact the hospital if you have any bleeding, abdominal pain, contractions or reduced fetal movements after ECV.

ECV is usually performed after 36 or 37 weeks of pregnancy. However, it can be performed right up until the early stages of labour. You do not need to make any preparations for your ECV.

ECV can be uncomfortable and occasionally painful but your healthcare professional will stop if you are experiencing pain and the procedure will only last for a few minutes. If your healthcare professional is unsuccessful at their first attempt in turning your baby then, with your consent, they may try again on another day.

If your blood type is rhesus D negative, you will be advised to have an anti-D injection after the ECV and to have a blood test. See the NICE patient information Routine antenatal anti-D prophylaxis for women who are rhesus D negative, which is available at: www.nice.org.uk/guidance/ta156/informationforpublic.

Why turn my baby head-first?

If your ECV is successful and your baby is turned into the head-first position you are more likely to have a vaginal birth. Successful ECV lowers your chances of requiring a caesarean section and its associated risks.

Is ECV safe for me and my baby?

ECV is generally safe with a very low complication rate. Overall, there does not appear to be an increased risk to your baby from having ECV. After ECV has been performed, you will normally be able to go home on the same day.

When you do go into labour, your chances of needing an emergency caesarean section, forceps or vacuum (suction cup) birth is slightly higher than if your baby had always been in a head-down position.

Immediately after ECV, there is a 1 in 200 chance of you needing an emergency caesarean section because of bleeding from the placenta and/or changes in your baby's heartbeat.

ECV should be carried out by a doctor or a midwife trained in ECV. It should be carried out in a hospital where you can have an emergency caesarean section if needed.

ECV can be carried out on most women, even if they have had one caesarean section before.

ECV should not be carried out if:

Is ECV always successful?

ECV is successful for about 50% of women. It is more likely to work if you have had a vaginal birth before. Your healthcare team should give you information about the chances of your baby turning based on their assessment of your pregnancy.

If your baby does not turn then your healthcare professional will discuss your options for birth (see below). It is possible to have another attempt at ECV on a different day.

If ECV is successful, there is still a small chance that your baby will turn back to the breech position. However, this happens to less than 5 in 100 (5%) women who have had a successful ECV.

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Breech baby at the end of pregnancy patient information leaflet

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ECV involves applying gentle but firm pressure on your abdomen to help your baby turn in the uterus to lie head-first. Relaxing the muscle of your uterus with medication has been shown to improve the chances of turning your baby. This medication is given by injection before the ECV and is safe for both you and your baby.

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NCT

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NICE Guidance (June 2023)

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Overview | Caesarean birth | Guidance | NICE

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This guideline covers when to offer and discuss caesarean birth, procedural aspects of the operation, and care after caesarean birth. It aims to improve the consistency and quality of care for women and pregnant people who are thinking about having a caesarean birth or have had a caesarean birth in…

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Obstetric Anaesthetists' Association (March 2020)

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NCT (July 2018)

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What is the third stage of labour?

The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out (Begley et al, 2011; NICE, 2017).

Once your baby's born, the release of the hormone oxytocin will make the uterus contract and become smaller. This'll make the placenta start to separate.

You will have some bleeding during the third stage of labour as you pass the placenta (Begley et al, 2011).

Active management versus physiological management

Generally, you have two options for how you do the third stage of labour: active management and physiological management. But there's also a third option - mixed management - combining active and physiological approaches (Begley et al, 2011; NICE, 2017).

Physiological management:

It's generally practised in midwife-led units and in home births.

It allows the placenta to be ready to come out mainly by pushing, gravity, contractions and sometimes by nipple stimulation.

It doesn't use oxytocin injections.

The umbilical cord is clamped and cut once it has stopped pulsing or when the placenta has come out.

It can take up to one hour (and shouldn't take more).

Skin-to-skin contact and breastfeeding can help it along, by making your body produce more oxytocin.

It involves sitting in an upright position to encourage the placenta to come out.

Your midwife will monitor your blood loss and keep you and your baby warm.

You'll push the placenta out once it has separated and moved down to your vagina.

It's mostly used if you're at low risk of heavy blood loss.

You can change to active management at any time if needed. (Begley et al, 2011; NICE, 2017)

When the placenta is out, your midwife will clamp and cut the cord. But if you want, you can ask them to wait until it has finished pulsating (RCM, 2013a). Delaying cord clamping for at least a minute has been shown to be beneficial for babies(Science Direct, 2021).

Active management:

Involves an injection of a drug called syntocinon or ergometrine in your thigh soon after your baby's born.

It speeds up the delivery of the placenta - it usually happens within 30 minutes of having your baby. Your midwife will apply some pressure to your belly and pull gently on the umbilical cord to ease the placenta out.

You'll have the umbilical cord cut between one and five minutes after you give birth.

It lowers the risk of heavy blood loss.

It might make you feel sick or vomit, and can increase your risk of high blood pressure.

(Begley et al, 2011; RCM 2013b; NICE, 2017)

Should I have active management or physiological management?

Generally, active management is recommended for all women, to avoid severe haemorrhage. Though this is more of an issue in low-income countries where women are more likely to be poorly nourished, anaemic or have infectious diseases (Begley et al 2015).

If you do go through a haemorrhage though, you'll need to be transferred to a hospital if you're not already there. You'll then be offered treatment that involves:

oxytocin or another drug called ergometrine, which helps the womb to contract and stop the bleeding

your placenta being removed if it hasn't been delivered already

fluids through a drip

oxygen through a facemask.

If the bleeding continues, you'll be given more oxytocin, ergometrine or other drugs. In some cases, an examination under anaesthesia and surgery and/or a blood transfusion might be needed (NICE, 2017).

Retained placenta and problems after birth

If all or some of your placenta has not come out within one hour of you having your baby, this is called a retained placenta.

If that happens to you, you'll need to be put on an intravenous drip. You might also be offered a vaginal examination to see whether you need an operation to remove the placenta. You'll also be offered pain relief (NICE, 2017).

If you do have the placenta removed under anaesthesia, you'll need to have it done within a few hours of the birth to avoid haemorrhage (Weeks, 2001). You'll then need to be transferred to an obstetric unit if you are not already there and might be advised to have an epidural or spinal anaesthetic when the placenta is actually removed (NICE, 2017).
This page was last reviewed in July 2018.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Important information on the third stage of labour can be found in NICE guidelines.

Begley CM, Gyte GML, Murphy DJ, et al. (2011) Active versus expectant management of women in the third stage of labour. Cochrane Database Syst Rev.(11):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

NICE. (2017) Intrapartum care for healthy women and babies. Available from: https://www.nice.org.uk/guidance/cg190/ifp/chapter/delivering-the-placenta [Accessed: 13th August 2018]

Rabe H, Gyte GML, Díaz‐Rossello JL, Duley L. (2019) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews. Available from: (9):CD003248. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003248.pub4... [Accessed: 4th October 2019]

RCM. (2013) How to conduct active management of the third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-conduct-active-management-of-the-third-stage-of-labour [Accessed: 13th August 2018]

Weeks AD. (2001) The retained placenta. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704447/] African Health Sciences. 1(1):36-41. [Accessed: 13th August 2018]

Science Direct (2021) A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns [Accessed: 27 August 2021] https://www.sciencedirect.com/science/article/abs/pii/S0301211521002098...
Further reading
Begley CM, Gyte GML, Devane D, McGuire W, Weeks A. (2015) Delivering the placenta with active, expectant or mixed management in the third stage of labour. Cochrane Database Syst Rev. 2015.(3):CD007412. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007412.pub3... [Accessed: 13th August 2018]

Jangsten E, Mattsson LA, Lyckestam I, Hellstrom AL, Berg M. (2011) A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial. British J Obst Gynaecol. 118(3):362-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21134105 [Accessed: 13th August 2018]

RCM. (2013) How to promote a physiological third stage of labour. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-promote-a-physiological-third-stage-of-labour [Accessed: 13th August 2018]

Midwife thinking An actively managed placental birth might be the best option for most women https://midwifethinking.com/2015/03/11/an-actively-managed-placental-bi...

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Third stage of labour: delivering placenta and cord clamping | Labour & birth articles & support | NCT

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The third stage of labour is the time between when you have your baby and when the placenta (or afterbirth) comes out.

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Nice Guideline on Intrapartum care (2023)

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1.3.2 Advise women that additional resources to help them plan their place of birth are available on the tools and resources page for this guideline and the NHS website. [2023]

1.3.5 Discuss with women the following information, including local statistics, about all local birth settings, and update them if this changes during their pregnancy:

access to medical staff (obstetric, anaesthetic and neonatal)

availability of birthing pools

access to pain relief, including Entonox (a 50:50 mixture of oxygen and nitrous oxide) and medicines (for example, pethidine, diamorphine, patient-controlled analgesia and regional analgesia)

the likelihood of being transferred to an obstetric unit (if this is not the woman's chosen place of birth), the reasons why this might happen, the time it may take, the delay in obstetric or neonatal care this may cause, and how her birth companion will travel; refer to table 1 if no local data is available.

More information on transfer to an obstetric unit for different groups of women is included in table 2 and table 4. [2014, amended 2023]

Main reason for transfer to an obstetric unit for each woman (there may be more than 1 reason)

From home (n=3,529)

From a freestanding midwifery unit (n=2,457)

From an alongside midwifery unit (n=4,401)

Source: Birthplace in England research study, 2011.

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This guideline covers the care of women and their babies during labour and immediately after birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy ('term'). The guideline helps women to make informed choices about where to have their baby and about their care in labour.

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Umbilical cord blood banking information 

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Umbilical cord blood banking information 

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https://www.hta.gov.uk/guidance-public/umbilical-cord-blood-banking
Human Tissue Authority (December 2021)

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Bridget Supple (September 2020)

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UNICEF Baby Friendly Initiative

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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Dr Jack Newman (2021)

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There are now a multitude of studies that show that mothers and babies should be together, skin to skin (baby naked, not wrapped in a blanket) immediately after birth, as well as later. The baby is happier, the baby's temperature is more stable and more normal, the baby's heart and breathing rates are more stable and more normal, and the baby's blood sugar is more elevated. Not only that, skin to skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother. This, plus breastfeeding, are thought to be important in the prevention of allergic diseases. When a baby is put into an incubator, his skin and gut are often colonized by bacteria different from his mother's.

We now know that this is true not only for the baby born at term and in good health, but also even for the premature baby. Skin to skin contact and Kangaroo Mother Care can contribute much to the care of the premature baby. Even babies on oxygen can be cared for skin to skin, and this helps reduce their need for extra oxygen, and keeps them more stable in other ways as well (See www.kangaroomothercare.com) (See the information sheet Breastfeeding the Premature Baby).

To appreciate the importance of keeping mother and baby skin to skin for as long as possible in these first few weeks of life (not just at feedings) it might help to understand that a human baby, like any mammal, has a natural habitat: in close contact with the mother (or father). When a baby or any mammal is taken out of this natural habitat, it shows all the physiologic signs of being under significant stress. A baby not in close contact with his mother (or father) by distance (under a heat lamp or in an incubator) or swaddled in a blanket, may become too sleepy or lethargic or becomes disassociated altogether or cry and protest in despair. When a baby is swaddled it cannot interact with his mother, the way nature intended. With skin to skin contact, the mother and the baby exchange sensory information that stimulates and elicits "baby" behaviour: rooting and searching the breast, staying calm, breathing more naturally, staying warm, maintaining his body temperature and maintaining his blood sugar.

From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least an hour, are more likely to latch on without any help and they are more likely to latch on well, especially if the mother did not receive medication during the labour or birth. As mentioned in the information sheet Breastfeeding-Starting out Right, a baby who latches on well gets milk more easily than a baby who latches on less well. See the video clips of young babies (less than 48 hours old) breastfeeding at the website nbci.ca. When a baby latches on well, the mother is less likely to be sore. When a mother's milk is abundant, the baby can take the breast poorly and still get lots of milk, though the feedings may then be long or frequent or both, and the mother is more prone to develop problems such as blocked ducts and mastitis. In the first few days, however, the mother does have enough milk, but because it is not abundant, as nature intended, the baby needs a good latch in order to get that milk. Yes, the milk is there even if someone has proved to you with the big pump that there isn't any. How much does or does not come out in the pump proves nothing-it is irrelevant. Many mothers with abundant milk supplies have difficulty expressing or pumping more than a small amount of milk. Also note, you can't tell by squeezing the breast whether there is enough milk in there or not. And a good latch is important to help the baby get the milk that is available. If the baby does not latch on well, the mother may be sore, and if the baby does not get milk well, the baby will want to be on the breast for long periods of time worsening the soreness.

To recap, skin to skin contact immediately after birth, which lasts for at least an hour (and should continue for as many hours as possible throughout the day and night for the first number of weeks) has the following positive effects. The baby:

Is more likely to latch on

Is more likely to latch on well

Maintains his body temperature normal better even than in an incubator

Maintains his heart rate, respiratory rate and blood pressure normal

Has higher blood sugar

Is less likely to cry

Is more likely to breastfeed exclusively and breastfeed longer

Will indicate to his mother when he is ready to feed

There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The baby may be placed vertically on the mother's abdomen and chest and be left to find his way to the breast, while mother supports him if necessary. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. This is baby's first journey in the outside world and the mother and baby should just be left in peace to enjoy each other's company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother's partner, but also a nurse, midwife, doula or physician stay with them-occasionally, some babies do need medical help and someone qualified should be there "just in case"). The eye drops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after cæsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.

Studies have shown that even premature babies, as small as 1200 g (2 lb 10 oz) are more stable metabolically (including the level of their blood sugars) and breathe better if they are skin to skin immediately after birth. Skin to skin contact is quite compatible with other measures taken to keep the baby healthy. Of course, if the baby is quite sick, the baby's health must not be compromised, but any premature baby who is not suffering from respiratory distress syndrome can be skin to skin with the mother immediately after birth. Indeed, in the premature baby, as in the full term baby, skin to skin contact may decrease rapid breathing into the normal range.

Even if the baby does not latch on during the first hour or two, skin to skin contact is important for the baby and the mother for all the other reasons mentioned.

If the baby does not take the breast right away, do not panic. There is almost never any rush, especially in the full term healthy baby. One of the most harmful approaches to feeding the newborn has been the bizarre notion that babies must feed every three hours. Babies should feed when they show signs of being ready, and keeping a baby next to his mother will make it obvious to her when the baby is ready. There is actually not a stitch of proof that babies must feed every three hours or by any schedule, but based on such a notion, many babies are being pushed into the breast simply because three hours have passed. The baby who is not yet interested in feeding may object strenuously, and thus is pushed even more, resulting, in many cases, in baby refusing the breast because we want to make sure they take the breast. And it gets worse. If the baby keeps objecting to being pushed into the breast and gets more and more upset, then the "obvious next step" is to give a supplement. And it is obvious where we are headed (see t he information sheet When a Baby Has Not Yet Latched).
The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.
This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don't know what this means, please email us to ask!

©IBC, updated July 2009

Questions or concerns? Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.

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International BreastFeeding Centre | The importance of skin to skin contact

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Babies who are not affected by medication and/or overhydration during the labour and birth will generally crawl to the breast and latch on without any help. This process takes an hour on average if the baby and mother are not disturbed. When the baby accomplishes

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NCT (August 2019)

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When it comes to giving birth, most women want to know: how much is it going to hurt and will I be able to cope with the pain? Unfortunately, you can't answer either of these questions with certainty. But what you can do is improve your ability to cope with pain during labour, as well as understand your options for pain relief and their impact on you, your labour and baby.

Your birth partner(s) will make a huge difference to how you feel during labour. Emotional support, such as encouragement and reassurance from somebody you trust, can really boost your confidence and ability to cope with pain when you need it most.

Here we look at the different pain relief options that are available during labour.

Overcoming fear during labour

Labour is complex but, unfortunately, fear can affect this amazing process.

Fear makes you release adrenaline, which slows down the production of oxytocin and prepares your body to fight or run away (not helpful when you're trying to give birth). This makes your contractions less efficient and you focus on the pain and feel worse. So staying calm is the key to coping with pain.

To help you feel relaxed, it's good to read up on what happens during labour and choose a place to give birth where you feel safe.

It'll help to choose the right person to be your birth partner to help you cope with the pain and discomfort of labour more easily. It should be a person you trust, and who can give you encouragement, reassurance, listen to you and just be there. Research has shown that emotional support is important for women in labour.

Attending antenatal classes is also a really useful way of preparing for labour and gaining an understanding of what will happen on the day.

If it feels really tough, ask your midwife how you are getting on. Positive encouragement - knowing you are coping really well and making good progress - can make all the difference.

Position and movement in labour

Labour can last a long time so, at the beginning, try movement, upright positions, massage and water to help you cope. If you head straight for maximum pain relief, you'll never know how other things can help - plus your labour may end up being even longer.

Lying on your back can make your contractions slower and more painful. Different positions and movement, such as rocking, swaying and leaning forwards, maximises your body's ability to give birth as it helps ease your baby along the birth canal.

Pros

Maximises your body's ability to give birth.

No lasting side-effects for you or your baby

Cons

Try not to overdo it; saving energy is also important. Lying on your side for a while or sitting up supported by lots of pillows can help your body to work really well while you conserve energy.

Water and birthing pools in labour

Water soothes pain and, in a large birthing pool, supports you, enabling you to glide into any position. For more about water births and using water during labour, see here.

TENS (Transcutaneous Electrical Nerve Stimulation) machine in labour

A TENS machine transmits mild electrical impulses to pads on your back. These block pain signals and help your body to produce endorphins. For more about the pros and cons of TENS, see here.

Complementary therapies

Various complementary therapies are available, such as acupuncture, aromatherapy, reflexology, yoga, self-hypnosis and massage.

Pros

Some studies show acupuncture is helpful.

Massage or pressure on the lower part of your back can help reduce levels of stress and ease discomfort, too.

You can learn self-hypnosis techniques for labour by attending a course or using CDs; you don't have to have a hypnotherapist with you in labour.

Cons

There is little research proving the effectiveness of these treatments though lots of women say that they found these techniques useful.

Apart from massage and self-hypnosis, you will need a registered practitioner to perform the therapies.

Sterile water injections

Sterile water injections involve injecting a tiny bit of water into the skin of your lower back to help with back pain during labour. For more about sterile water injections, see here.

Gas and air (Entonox) in labour

Entonox is a colourless, odourless gas made up of half nitrous oxide and half oxygen. You'll probably be given gas and air through a mouthpiece and told how to breathe it in. Read more about Entonox here.

Painkilling drugs in labour (opioids such as pethidine, diamorphine, meptid and remifentanil)

Pethidine, diamorphine and meptid are pain relieving drugs given by injection into the thigh. Some hospitals offer remifentanil, which is a very strong, short-acting painkiller given via a drip that you can control yourself using a machine. For more details, see our articles about intramuscular opioids and remifentanil.

Epidural

Epidural analgesia is a local anaesthetic injected into the space between two vertebra in your back. It usually removes all pain and most feeling from the waist down.

The combined spinal epidural (CSE) injection contains a low dose of pain-relieving drugs and works more quickly than an epidural alone. Read more about their pros and cons in our articles about epidurals and CSEs.

Top tips for labour

The following tips have been found to be useful by women in labour:

1. Before labour, spend some time imagining having your new baby in your arms after the birth and that all is well. Imagining that you did it, and that you did it as you wanted, creates a positive picture to focus on.

2. Moving about helps labour to progress and women have said they were better able to work with the pain while rocking and leaning forwards (the pressure of the baby's head on the cervix will promote the release of oxytocin as well as endorphins - the body's natural pain relievers). Focus on letting go and relaxing any muscles that aren't needed to hold you in a position.

3. Focus on the out breath during a contraction. Keep the breathing calm and rhythmic.

4. Make a noise if you want to - be somewhere with people that are happy for you to moan, grunt, sigh or even swear if that helps.

5. Belly-dancing, hip-wriggling and stepping movements all help your baby settle into a good position to be born.

6. Massage or pressure on the lower part of your back just above the top of your bottom can help.

7. Water helps women relax and move more easily; being in a pool can give women a feeling of safety and security.

8. Positive, affirmative thoughts and supportive comments from birth partners help to promote confidence in the process. 'You are doing well - your body is made for this - feel the power of your body - your body knows how to do this - each pain is progress' are all positive and encouraging statements.

9. During labour, think about welcoming each contraction. As your contractions become stronger, longer and closer together your body is getting ready to give birth.

10. Rest, relax and conserve energy between contractions as labour progresses.

11. Have confidence in your own self-help resources.

12. Acknowledge that labour is unpredictable and that uncertainty is difficult to go along with. Try to go with the flow.

Recognising the point at which labour feels worst - when you have had enough - is often the point just before you are ready to start pushing your baby out. Having people with you who help you feel strong and capable can make all the difference.

Do what feels best for you

Every labour is different and each woman should choose whatever she needs to help her work with the pain of labour. Most importantly, have confidence that you can do it.
This page was last reviewed in August 2019.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy and life with a new baby.

NHS Choices guide to pain relief.

Research from the Royal College of Obstetricians and Gynaecologists (RCOG) about the use of water as pain relief in labour.

Information from NHS Choices about complementary therapies during pregnancy and before birth.

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Pain relief in labour | Labour & birth articles & support | NCT

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Find out about the different options available for pain relief in labour and childbirth, including epidural, pethidine, TENS and other ways to reduce pain.

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Obstetric Anaesthetists' Association

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Labour can be painful, so it can help to learn about the pain relief options available to you. The main methods fall into two categories: with medication and without medication. Your anaesthetist will guide you through your options to find the one that works best for you and your baby.

Pain relief methods with medication

Pain relief methods without medication

Compare different pain relief methods

Understanding your pain relief options can be daunting. To help in your decision making, use our comparison table to learn more about the different options available and how they vary from each other.
Pain relief comparisons

Other information related to labour pain relief

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Pain relief and anaesthesia choices during labour

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Labour can be painful, so it can help to learn about the pain relief options available to you. The main methods fall into two categories: with medication and without medication. Your anaesthetist will guide you through your options to find the one that works best for you and your baby.

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Available in other languages from https://www.labourpains.org/translated-information/overview

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Available in other languages from https://www.labourpains.org/translated-information/overview

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NCT March 2021

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How to do perineal massage: a step-by-step guide | Pregnancy, Worries and discomforts articles & support | NCT

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So you know perineal massage might help you to avoid perineal tears and you’re keen to try it out. Read on for our guide to how to massage your perineum.

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Video by 2 midwives

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How To Do Perineal Massage - Taught By Two Midwives

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In this video we teach you how to prepare your perineum for birth. You can find my antenatal courses here https://www.thehypnobirthingmidwife.co/hypnobirthingcourses/ And my FREE relaxation MP3 here https://www.thehypnobirthingmidwife.co/free-hypnobirthing-mp3s-downloads-cd/ Much love Nissa x

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Expert midwives and perineal care during birth

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Expert midwives and perineal care during birth

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Sara Wickham

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A study published in Women and Birth has offered further insight into the knowledge and skills used by expert midwives in keeping women's perineums intact during birth. Led by Cecily Begley, the researchers interviewed midwives in New Zealand and Ireland in order to explore what might lie behind their low rates of perineal trauma ( Begley et al 2018).

This kind of research is so valuable, because the richness of the data can help us to understand and explore the issues in more depth than when we only have quantitative data relating to a population of women. The findings give us some clues as to why women who birth with a midwife may have a higher chance of an intact perineum, and they may also help explain differences between the outcomes seen in different environments of care.

Here's a summary of the study (Begley et al 2018), but I wholeheartedly recommend reading the entire paper if you can get hold of it.

The Research:

Background: The perineum stretches during birth to allow passage of the baby, but 85% of women sustain some degree of perineal trauma during childbirth, which is painful post-partum. Episiotomy rates vary significantly, with some countries having rates of >60%. Recent Irish and New Zealand studies showed lower severe perineal trauma and episiotomy rates than other countries.

Aim: To explore expert Irish and New Zealand midwives' views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth.

Methods: Following ethical approval a qualitative, descriptive study was undertaken. Semi-structured, recorded, interviews were transcribed and analysed using the constant comparative method. Expert midwives employed in New Zealand and one setting in Ireland, were invited to join the study. "Expert" was defined as achieving, in the preceding 3.5 years, an episiotomy rate for nulliparous women of <11.8%, a 'no suture' rate of 40% or greater, and a severe perineal tear rate of <3.2%. Twenty-one midwives consented to join the study.

Results: Four core themes emerged: 'Calm, controlled birth', 'Position and techniques in early second stage', 'Hands on or off?' and 'Slow, blow and breathe the baby out.' Using the techniques described enabled these midwives to achieve rates, in nulliparous women, of 3.91% for episiotomy, 59.24% for 'no sutures', and 1.08% for serious lacerations.

Conclusions: This study provides further understanding of the techniques used by expert midwives at birth. These findings, combined with existing quantitative research, increases the evidence on how to preserve the perineum intact during spontaneous birth.

Begley C, Guilliland K, Dixon L et al (2018). A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women and Birth, in press, https://doi.org/10.1016/j.wombi.2018.04.015

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Expert midwives and perineal care during birth - Dr Sara Wickham

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A study published in Women and Birth has offered further insight into the knowledge and skills used by expert midwives in keeping women's perineums intact during birth. Led by Cecily Begley, the researchers interviewed midwives in New Zealand and Ireland in order to explore what might lie behind their low rates of perineal trauma ( Begley et al 2018).

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Royal College of Obstetricians and Gynaecologists (2019)

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This information is for you if you are pregnant and would like to know more about perineal tears during childbirth

It may also be helpful if you are a partner, friend or relative of someone who is in this situation.

Read, listen, or download versions of the poster.

You can find further information on the RCOG perineal tears hub.

Text version: Perineal tears during childbirth

What you need to know during pregnancy

After the birth of your baby a healthcare professional will offer you an examination to see if you have a tear. They will advise you if you need stitches. Most tears heal within 6 weeks with no long-term problems. For women who do have problems after a tear (such as pain, difficulty going to the toilet, incontinence or mental health problems) specialist help is available.

Approximately 6 out of 100 women giving birth for the first time and 2 out of 100 women who have given birth vaginally before will have a deeper tear involving the back passage/anal sphincter muscle (a 'third- or fourth-degree tear'). These deeper tears will need repair in an operating theatre. You will be supported by healthcare professionals including physiotherapists after your recovery from a third- or fourth-degree tear.
Image 1: Anatomy of the perineum without tears
Perineal massage and 'hands-on' birth

A kneeling or all-fours birthing position may be beneficial and reduce the severity of tearing.

You can ask your healthcare professional to support your perineum as your baby is being born, which reduces the risk of a third- or fourth-degree tear. This is called 'hands-on' birth.

From 35 weeks onwards, you may choose to try perineal massage until your baby is born, which has been shown to reduce the risk of tears. This is particularly beneficial for first-time mothers. You may wish to ask your partner to help with this.
Image 2: Example of perineal massage
Top tips

1. Use lubricant like vitamin E oil, almond oil or olive oil.

2. Hold one or both of your thumbs in the position shown for about one minute. You will begin to feel a stretching sensation. Keep breathing.

3. Gently massage the lower half of your vagina using a U-shaped movement for 2-3 minutes. Do this 2-3 times.

4. Repeat the massage daily, or when possible.

For more information about the types of tears that can happen in childbirth, and what can be done to help your recovery if you do tear, visit the RCOG perineal tears hub.

Sources and acknowledgements

This information has been developed by the OASI Care Bundle Project Team, OASI Care Bundle Clinical Champions and the RCOG Patient Information Committee.

It is based on the RCOG Green-top Guideline No. 29 The Management of Third- and Fourth-degree Perineal Tears, published in June 2015, and on expert opinion of the OASI Care Bundle Project Team, Clinical Champions, key stakeholders and the RCOG patient Information Committee, in line with RCOG due process. The guideline contains a full list of the sources of evidence we have used.

Before publication this information was reviewed by the public, by the RCOG Women's Network and by the RCOG Women's Voices Involvement Panel.

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This information is for you if you are pregnant and would like to know more about perineal tears during childbirth. It may also be helpful if you are a partner, friend or relative of someone who is in this situation.

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Birthful podcast with Rachel Reed

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Kristina Colangelo visualized a flowing birth, but the reality caught her by surprise. Fortunately, her dad, mom, doula, and midwife supported her through a long labor due to a posterior baby, prolonged hyperemesis gravidarum, and the fear of tearing. She tells...

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Protecting Your Perineum, with Rachel Reed - Birthful

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The thought of vaginal tearing can make any woman cringe. And let's not even think about episiotomies. Are there ways to avoid tearing? What's the evidence behind perineal massage? Will being told how to push make things worse? Rachel Reed tells us more about protecting your perineum during birth.

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The Miles Circuit - how to help labour progress

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The Miles Circuit - how to help labour progress

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There is no evidence that these exercises will help induce labour but getting your baby into a good position will help labour to progress (July 2020)

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The Miles Circuit | How to Help Labor Progress and Naturally Induce Labor on Your Own

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NCT

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Your guide to labour | Information and support for labour & birth | NCT

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What really happens during labour and what can you expect and prepare for? Read about each stage here.

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Making the most of your pelvis for birth

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Making the most of your pelvis for birth

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Lynn Frost, NCT Antenatal Teacher (July 2021)

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Encouraging your baby into a good position for labour

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Encouraging your baby into a good position for labour

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Babycentre UK

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Thinking of using a birthing ball during your pregnancy? Our expert explains how to choose the right one for your height, and how to use it during pregnancy and labour.

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Doula Nikia Michelle coaching Deana E on a birth ball

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NCT

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Share your videos with friends, family, and the world

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Intrapartum care for healthy women and their babies

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Intrapartum care for healthy women and their babies

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NICE Guidance (February 2017)

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Care of women and their babies during labour and birth | Information for the public | Intrapartum care for healthy women and babies | Guidance | NICE

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This guideline covers the care of healthy women and their babies, during labour and immediately after the birth. It focuses on women who give birth between 37

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Intrapartum Care for women with existing medical conditions or complications

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Intrapartum Care for women with existing medical conditions or complications

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NICE Guidance (April 2019)

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Care during labour and birth for women with a medical condition or complication in pregnancy or labour

Most women have no problems during labour and birth, but some need extra care because they have a higher chance of complications. For example, this could be because:

they have had a caesarean section in a previous pregnancy

the baby is thought to be either very small or large

a problem happens during early labour, for example, the baby turns bottom down (called 'breech') instead of being head down

they have a medical condition, like heart or kidney disease.

We want this guideline to make a difference to women and babies needing extra care during labour and birth by making sure that care teams:

involve women in decisions about care at every stage

explain what it means if a complication happens during labour and how this might affect any choices women have made in their birth plan

explain why continuous monitoring of the baby's heart rate might be recommended during labour to check the baby is coping well

discuss options for labour and birth with women with medical conditions and include specialists for those conditions.

Making decisions together

Decisions about treatment and care are best when they are made together. Your care team should give you clear information, talk with you about your options, answer your questions and listen carefully to your views and concerns.

They should also:

make sure that if there is a complication during labour, you fully understand what's happening, and what may happen next

make sure you understand the benefits and risks to you and your baby of different options, including any uncertainties

respect what matters to you and support your plans and wishes for giving birth as far as possible.

If you can't understand the information you are given, tell the care team who are looking after you.

Read more about making decisions about your care.

Where can I find out more?

The NHS website has more information about what happens during labour and birth and pregnancy for women with existing health conditions.

The organisations below can give you more advice and support.

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people involved in supporting women who need extra care during labour and birth. All the decisions are based on the best research available.

ISBN: 978-1-4731-3297-9

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Intrapartum care for women with existing medical conditions or obstetric complications and their babies

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Most women have no problems during labour and birth, but some need extra care because they have a higher chance of complications.

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Book - Bump, How to Make, Grow and Birth a Baby 

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Book - Bump, How to Make, Grow and Birth a Baby 

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Kate Evans

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Evans deftly handles the physical and emotional changes that come with being pregnant, looking at the practicalities of every stage as well as the challenges that may arise. Thoroughly researched and beautifully written, Kate Evans' no-nonsense, quirky and accessible text is illustrated throughout with detailed artwork to guide the reader through the intricacies of human reproduction whilst her customary laugh-out-loud cartoons demystify the complexities of pregnancy and birth.

Your review has been submitted successfully.

# data[].attributes.attachment_link.description
Evans deftly handles the physical and emotional changes that come with being pregnant, looking at the practicalities of every stage as well as the challenges that may arise. Thoroughly researched and beautifully written, Kate Evans' no-nonsense, quirky and accessible text is illustrated throughout with detailed artwork to guide the reader through the intricacies of human reproduction whilst her customary laugh-out-loud cartoons demystify the complexities of pregnancy and birth.

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Book - Let's talk about preparing for your baby's birth

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Book - Let's talk about preparing for your baby's birth

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Jackie Keitz

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Information

In this 'antenatal course in a book', experienced hypnobirthing and antenatal practitioner Jackie Kietz discusses labour and birth in the way that it would be covered at face-to-face birth preparation classes.

From how to tell whether you're really in labour, to choosing where and how to give birth and communicating your wishes to healthcare staff, the book is packed with essential information for new parents. As well as practical details, there are also MP3s and suggestions for ways to relax using hypnobirthing and breathing techniques to help you think positively about your upcoming birth.

As a useful reminder of what's covered in a course, or as a substitute if you don't want to or can't attend classes in person, this friendly, easy to follow and reassuring book is invaluable for anyone expecting a baby.

Press reviews and endorsements

Straightforward, practical and succinct - this book contains everything you need to know about labour and birth. With easy-to-read explanations about how birth works and what you and your birth partner can do to optimise this magnificent and powerful physiological process, it also addresses the 'I'm not allowed' narrative and equips you to make informed decisions about your maternity care. Being prepared is important, and knowledge is power! You don't give birth every day, so why not make it the best day possible and read this book? Molly O'Brien - Optimal Birth

Pinter & Martin Why it Matters

6 Effra Parade London SW2 1PS UK 020 3633 6879

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Let's talk about preparing for your baby's birth

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In this 'antenatal course in a book', experienced hypnobirthing and antenatal practitioner Jackie Kietz discusses labour and birth in the way that it would be covered at face-to-face birth preparation classes. From how to tell whether you're really in labour, to choosing where and how to give birth and communicating your wishes to healthcare staff, the book is packed with essential information for new parents.

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Milli HIll

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Information

Work out what kind of birth you really want, and learn how to maximise your chances of getting it, in this refreshing, warm and witty guide to pregnancy, birth and the early weeks. Packed with vital and cutting-edge information on everything from building the ultimate birth plan, to your choices and rights in the birth room; from optimal cord clamping, to seeding the microbiome; from the inside track on breastfeeding, to woman-centred caesarean, The Positive Birth Book shows you how to have the best possible birth, regardless of whether you plan to have your baby in hospital, in the birth centre, at home or by elective caesarean. Find out how the environment you give birth in, your mindset and your expectations can influence the kind of birth you have, and be inspired by the voices of real women, who tell you the truth about what giving birth really feels like.

Challenging negativity and fear of childbirth, and brimming with everything you need to know about labour, birth, and the early days of parenting, The Positive Birth Book is the must-have birth book for women of the 21st century.

NEWS: The Positive Birth Book Visual Birth Plan Cards are now available.

You can download the visual birth plan icons from the book here: The Positive Birth Book Visual Birth Plan (free download).

Press reviews and endorsements

"Seriously sound, straight-from-the-hip advice." Mother&Baby Magazine

"One of my very favourite birth writers." Ricki Lake

"The Positive Birth Book takes expectant parents through the maze of information and choices, in a down to earth, practical, empowering, reassuring way. I highly recommend that you put your feet up, relax and enjoy preparing yourself for the birth of your baby by reading this great book." Sue Atkins, ITV This Morning Parenting Expert

"A great read: honest, lively, fresh and helpful. This book puts women in the driving seat which is key to positive change." Cathy Warwick, Chief Executive of the Royal College of Midwives

"Whatever a positive birth means to you, this book will make you believe you can do it. It's the book I wish I had read before I had my children!" Green Parent Magazine

"It's everything a pregnant woman and her partner needs, in one fab book!" Sheena Byrom OBE, Midwife and Honorary Fellow of the Royal College of Midwives

"I love this book. Everyone's going to love this book. Because it gives mothers what they now most need - accurate facts, proper reassurance, and about a thousand reasons to be excited about birth." Natalie Meddings, Founder of Tellmeagoodbirthstory

"Chatty and thorough and uplifting: this book is a whacking great confidence boost right where it's needed." Kate Evans, Author of Bump: How to Make, Grow and Birth a Baby

"The Positive Birth Book is a must-read for every mum-to-be. By showing that birth can be an amazing, empowering and life-enhancing experience, Milli Hill is giving birth to a whole new way to think about bringing life into the world." Siobhan Freegard, Founder of Channel Mum and Netmums

"Finally, we can put to bed the old saying that 'as long as mother and baby are healthy that is all that matters.' Having a positive birth experience can be even more healthy, not just for the physical well being mom and newborn, but for their state of mind. This book shows how birth can be transformative. Don't give birth without it!" Tina Cassidy, Author of Birth: The Surprising History of How We Are Born

"This is a book for all women-whether they will be on the normal birth pathway or have more complex needs, and whatever their take on things. The Positive Birth Book brings together complex ideas, material and research and it is all written so clearly. The words of women who have given birth are exquisite, and I so appreciated the inclusion of topics like human rights in birth and the importance of continuity of care. We are confronted with a huge job of raising women's expectations and transforming the culture of birth at the moment - and this book will really help. I loved it." Lesley Page, President of the Royal College of Midwives

Reviews

(2 reviews) Write a Review
2 Reviews

4
The Positive Birth Book

Posted by Edward on 25th Apr 2018

This book is brilliant. In the polarised and distracting debate between 'earth mothers' and epidurals, all that really matters is that parents choose what they would prefer. Of course, Mr Stork may throw in a couple of curve balls, but you have loads of options and knowledge is power.

5
A really wonderful resource

Posted by Karen Hall on 21st Mar 2017

This is an interesting and extremely thorough manual for birth, written by Positive Birth Movement founder Milli Hill, whose passion for improving childbirth shines out of every page.&lt;br /&gt;&lt;br /&gt;The obvious comparison is with &#039;How to Grow a Baby and Push It Out,&#039; being published around the same time and for a similar audience. But The Positive Birth Book is much less yummy mummy guidebook and more thinking woman&#039;s handbook, with comprehensive chapters looking in depth at the decisions to make during pregnancy, the experience of labour, different kinds of support, ways of working with pain, and a lot less shopping.&lt;br /&gt;&lt;br /&gt;Hill takes a strong evidence-based position, referring extensively to NICE guidelines, and with contributions from other very respectable authorities including Birthrights&#039; Rebecca Schiller and ABM Chair Emma Pickett. Usually I skip through the personal anecdotes, but they have been used really effectively in this book, breaking up an otherwise non-stop march of densely factual information.&lt;br /&gt;&lt;br /&gt;A particular strength of The Positive Birth Book is the chapter describing what labour is &amp;quot;really like.&amp;quot; A tricky subject to cover, given all the possible individual experiences, and inevitably it&#039;s a long chapter with some idiosyncratic but accurate descriptions. Hill goes on to argue the case for writing a birth plan, and she&#039;s right that the process involves some engagement with the subject rather than washing one&#039;s hands of any involvement in what might unfold. This is a difficult case to make, knowing that so many women struggle to come to terms with disappointment and grief when birth doesn&#039;t meet their expectations. There is a good case for providing information and some decision-making strategies, which this book also does. A cute &#039;visual birth plan&#039; tool is also offered.&lt;br /&gt;&lt;br /&gt;A final chapter provides a taster of post-birth existence, touching on the fourth trimester concept, some basic but happily accurate information about breastfeeding, and postnatal feelings and changes. Here Hill signposts rather than going into much detail, since this would go beyond the remit of this already very detailed book.&lt;br /&gt;&lt;br /&gt;I know that much inspiration and information for The Positive Birth Book was crowd-sourced, and the results have been articulately curated by Milli Hill into a really wonderful resource for pregnant women who are keen to do their research and take ownership of their birth experience.

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6 Effra Parade London SW2 1PS UK 020 3633 6879

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The Positive Birth Book: A new approach to pregnancy, birth and the early weeks

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Work out what kind of birth you really want, and learn how to maximise your chances of getting it, in this refreshing, warm and witty guide to pregnancy, birth and the early weeks.

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Book - The AIMS Guide to Your Rights in Pregnancy & Birth

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Book - The AIMS Guide to Your Rights in Pregnancy & Birth

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Emma Ashworth

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AIMS Guide to Your Rights in Pregnancy and Birth

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Milli Hill

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As featured on BBC Radio 2 and BBC Radio 5 Live Selected as one of the Independent's 10 best pregnancy books for expectant parents

Birth is a feminist issue. It's the feminist issue nobody's talking about.

For too long women have been told, 'a healthy baby is all that matters'. This book dares to say women matter too.

Finally blasting the feminist spotlight into the labour ward, Milli Hill encourages women everywhere to stand and deliver, insisting that birth is no longer left off the list in discussions about female power, control and agency.

From the importance of birth plans to your human rights in childbirth, and including birth stories from women across the world, this call-to-arms will help you find your voice, take an active role in your choices, and change the way you think about childbirth.

Praise for Give Birth Like a Feminist

'I feel so lucky to have read Milli's book while pregnant, she completely changed my way of looking at giving birth' Ella Mills, author of Deliciously Ella

MEDIA REVIEWS

'I feel so lucky to have read Milli's book while pregnant, she completely changed my way of looking at giving birth' Ella Mills, author of Deliciously Ella

'Milli is a compassionate and passionate writer who puts women squarely at the heart of her endeavours.' Emma Barnett, Woman's Hour

'A much-needed, brilliant, reassuring, pioneering, kick-ass book that all women - especially mothers - should read!' Emma Jane Unsworth

'Milli Hill is one of our very favourite birth writers. Birth has been overlooked by feminists for too long, in spite of the injustices happening in the labour ward. This book is a rallying cry for women everywhere to take charge of their births and recognise their own autonomy at this pivotal moment in their lives. Everyone should read it and look at the experience of childbirth through a feminist lens.' Ricki Lake, Producer and Abby Epstein, Director: The Business of Being Born

'Whether a person is considering giving birth or not, Milli Hill's exploration of childbirth as a central feminist issue is a must-read. I loved this book!' Soraya Chemaly

'Everyone should read this awesome book! The world has changed and Milli Hill connects the dots in a way that can change minds and improve outcomes.' Tina Cassidy

'Finally. Someone brave enough to say the words "feminist" and "birth" in the same sentence in a book that is not an academic polemic.' Hannah Dahlen

"A vitally important book, regardless of whether you're pregnant"

So when I started reading this book, I thought it sounded like an interesting topic, and I was planning to start trying to have a baby soon, so it seemed like a particularly good time to read up on the topic. Then... More

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Give Birth Like a Feminist by Milli Hill | Waterstones

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As featured on BBC Radio 2 and BBC Radio 5 Live Selected as one of the Independent's 10 best pregnancy books for expectant parents Birth is a feminist issue. It's the feminist issue nobody's talking about. For too long women have been told, 'a healthy baby is all that matters'.

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Katrina Berry

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Information

Hypnobirthing is a method of birth preparation using a series of simple but effective techniques that can facilitate a calm and natural birth. Far from being a modern fad, it is logical, rational and there is a strong evidence base for its use. Many women approach labour with fear because of the negativity surrounding birth and the assumption that it must involve excruciating pain for the mother. Fear has a physiological effect, making contractions less effective and derailing normal labour. Hypnobirthing teaches the mother to relax and believe that her body is perfectly designed to give birth; when the mother is relaxed her body can release natural painkillers that are far more effective than pharmaceutical drugs. Women using hypnobirthing report needing little or no pain relief during labour and their babies are born calm and alert. Mothers need less medical intervention, and if they do they report feeling much more able to deal with it. Calm and confident parents are empowered to make informed decisions about their care, which can contribute enormously to a positive birth experience.

In Why Hypnobirthing Matters Katrina Berry looks at the origins and rationale for using hypnosis for childbirth, explains what you can expect from hypnobirthing and dispels common misunderstandings in a lively, informative way.

6 Effra Parade London SW2 1PS UK 020 3633 6879

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Hypnobirthing is a method of birth preparation using a series of simple but effective techniques that can facilitate a calm and natural birth. Far from being a modern fad, it is logical, rational and there is a strong evidence base for its use.

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Maddie Mcmahon

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Pinter & Martin is an independent publishing company specialising in pregnancy, birth, parenting, breastfeeding, yoga and psychology books

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Out of the Laboratory: Back to the darkened room

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Out of the Laboratory: Back to the darkened room

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Tricia Anderson

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Out of the Laboratory: Back to the Darkened Room

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Out of the laboratory: back to the darkened room is one of the best articles on homebirth I've read. Tricia Anderson, who passed away in 2007, had a special gift as a midwife and a writer. I wanted to honour her by keeping some of her work alive.

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Dr Sarah Buckley

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by Dr Sarah Buckley

Imagine this. Your cat is pregnant, due to give birth around the same time as you are. You have your bags packed for hospital, and are awaiting the first signs of labour with excitement and a little nervousness.

Meanwhile your cat has been hunting for an out-of-the way place - your socks drawer or laundry basket - where she in unlikely to be disturbed. When you notice, you open the wardrobe door, but she moves again. Intrigued, you notice that your observation - even your presence - seems to disturb the whole process. And, wish as you might to get a glimpse into the mysteries of birth before it is your turn, you wake up the next morning to find her washing her four newborn kittens in the linen cupboard.

Why does birth seem so easy to our animal friends when it is so difficult for us?

One obvious difference is the altered shape of the pelvis and birth outlet that is caused by our upright stance; our babies need to twist and turn to navigate these unique bends. Even our nearest cousins, the great apes, have a near-straight birth canal.

However, in every other way, human birth is like that of other mammals - those animals that suckle their young - and involves the same hormones - the body's chemical messengers. These hormones, which originate in the deepest and oldest parts of our brain, cause the physical processes of labour and birth, as well as exerting a powerful influence on our emotions and behaviour.

Researchers such as French surgeon and natural birth pioneer Michel Odent believe that if we can be more respectful of our mammalian roots, and the hormones that we share, we can have more chance of a straightforward birth ourselves.

Labour and birth involve peak levels of the hormones oxytocin, sometimes called the hormone of love, and prolactin - the mothering hormone. These two hormones are perhaps best known for their role in breastfeeding. As well as these, beta-endorphin, the body's natural pain-killer, and the fight-or-flight hormones adrenaline and noradrenaline play an important part in the birth process. There are many more hormonal influences on birth that are not well understood.

All mammals seek a safe place to give birth. This "nesting" instinct may be due to an increase in levels of prolactin, which is sometimes referred to as the nesting hormone. At this stage, as you may have observed with your cat, interference which the nest - or more importantly with the feeling of safety - will stall the beginning of labour.

Even after labour has started, there are certain conditions that will slow, or even stop the process. If the fight-or-flight hormones are activated by feelings of fear or danger, contractions will slow down. Our mammalian bodies are designed to give birth in the wilds, where it is an advantage to postpone labour when there is danger, and to seek safety.

Many women have had the experience of their labour stopping when they entered the unfamiliar surroundings of a hospital, and some women can be as sensitive as a cat to the presence of an observer. Giving birth away from our natural environment can cause the sorts of difficulties for us that captive animals experience when giving birth in a zoo.

Michel Odent cautions that even hunger, which also causes the body to release fight-or-flight hormones, can stop labour from progressing. He advises women to eat- if they are hungry- in the earliest stages of labour; many hospitals, though, have a policy which prevents labouring women from eating once they are admitted.

Oxytocin is the hormone that causes the uterus to contract during labour. Levels of oxytocin gradually increase throughout labour, and are highest around the time of birth, when it contributes to the euphoria and receptiveness to her baby that a mother usually feels after an unmedicated birth. This peak, which is triggered by sensations of stretching of the birth canal as the baby is born, does not occur when an epidural is in place. Administration of an epidural has been found to interfere with bonding between ewes and their newborn lambs.

Synthetic oxytocin is often given by drip - that is, directly into the bloodstream - when labour contractions are inefficient. Oxytocin given in this way does not enter the brain, and so does not contribute to the post-birth "high", and in fact can lead to a reduction in a mothers own oxytocin production. Nipple stimulation is sometimes used to stimulate contractions because, like breastfeeding, this causes oxytocin levels to increase.

Oxytocin has another crucial role to play after the birth. Oxytocin causes the contractions that lead to separation of the placenta from the uterus, and its release as the "after-birth". When oxytocin levels are high, strong contractions occur that reduce the chance of bleeding, or post-partum haemorrhage.

Putting your newborn baby to your breast is the easiest way to increase oxytocin levels, but Michel Odent also emphasises the importance of privacy during the hour following birth. This gives the opportunity for uninterrupted skin-to-skin and eye-to-eye contact between mother and baby - conditions that optimise oxytocin release.

Oxytocin helps us in our emotional, as well as our physical, transition to motherhood. From the first weeks of pregnancy, oxytocin helps us to be more emotionally open and more receptive to social contact and support. As the hormone of orgasm, labour and breastfeeding, oxytocin encourages us to "forget ourselves", either through altruism - service to others - or through feelings of love.

The fight or flight hormones- also called catecholamines (pronounced cat-e-kol-a-meens), or CAs- can interfere with oxytocin release during labour and after the birth. However they do have an important role to play in the second stage of labour, which is when birth actually occurs.

Early in second stage, when the cervix is fully open but the urge to push is not yet strong, a woman can feel the need to rest for some time. This is known as 'transition'- or the 'rest and be thankful' time. After this, she may quite suddenly experience the dry mouth, dilated pupils and sudden burst of energy that are all characteristic of high levels of CAs.

This burst of CA's gives a mother the energy to push her baby out, and Michel Odent observes that, when unmedicated, women usually want to be upright at this time. Some traditional cultures have used this fight-or-flight effect to help women having difficulty with the delivery by surprising or shouting out at this stage. It makes sense, at this point-of-no-return, for fear or danger to speed up the birth, so that a mother can gather up her newborn baby and run for safety.

CA levels drop quickly after the birth, which can make a mother may feel cold or shaky. At this stage a very warm atmosphere is essential, according to Michel Odent, to keep CA levels low and to allow oxytocin to work effectively to prevent bleeding.

The other major birthing hormone, prolactin is most noteworthy for its effects after the birth. Prolactin is the major hormone of breast milk synthesis. Suckling by the newborn baby increases prolactin levels; early and frequent suckling from the first days makes the breast more responsive to prolactin, which in turn helps to ensure a good long-term supply of milk.

Like the other hormones, prolactin has effects on emotion and behaviour. Prolactin stimulates 'aggressively defensive' behaviour in breastfeeding mothers- what I call the 'tiger mother' effect. As well as this, prolactin helps us to put our babies needs first in all situations by increasing submissiveness, anxiety and vigilance.

When prolactin is combined with oxytocin, as it is soon after birth and during breastfeeding, it encourages a relaxed and selfless devotion to the baby that contributes to a mother's satisfaction and her baby's physical and emotional health.

Beta endorphin (pronounced beet-a en-door-fin) is one of the endorphin hormones which are released by the brain in times of stress or pain, and is a natural equivalent to painkilling drugs like pethidine.

During labour, beta-endorphin helps to relieve pain, and contributes to the "on another planet" feeling that women may experience when they labour without drugs. Levels of beta-endorphin are reduced when drugs are used for pain relief.

Very high levels of beta-endorphin can slow labour by reducing oxytocin levels, which may help to 'ration' the intensity of labour according to our ability to deal with it. Moderate levels of beta-endorphin help us to deal with pain in labour, as well as encouraging us to follow our instincts. As part of the hormonal cocktail after birth, beta-endorphin plays a role in bonding between mother and baby, who is also primed with endorphins from the birth process.

Beta-endorphin also switches on learning and memory, perhaps explaining why we remember our labour and birth in such amazing detail. Like oxytocin, endorphin hormones can induce a euphoria and are also released during lovemaking and breastfeeding. In fact endorphins are actually present in breast milk, which explains the natural high that babies can get after a breast-feed. Beta-endorphin helps the body to release prolactin, underlining the elaborate interplay between these hormones of labour, birth and breastfeeding.

So there you are, at the door, with your bag in your hand and a strong contraction. You remember the oxytocin and endorphins, which you also carry with you, and with your next relaxed breath, you breathe out all of your fear and tension. You've packed your new nursing bra, and you know that prolactin will come to your aid as well. As you take a last look around the house, you notice your cat.

She's lying down as her kittens attach to her nipples, and as you catch her eye, she winks at you.

The author can be contacted @ sarahjbuckley@uqconnect.net

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Pain in Labour - Your Hormones are Your Helpers

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by Dr Sarah Buckley Imagine this. Your cat is pregnant, due to give birth around the same time as you are. You have your bags packed for hospital, and are awaiting the first signs of labour with excitement and a little nervousness.

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NCT

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Caesarean information for birthing partners

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Caesarean information for birthing partners

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OAA (2016)

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During an elective (planned) caesarean birth, there is usually no rush when your baby is born. If agreed beforehand, the obstetrician can lie your baby down before cutting the cord to help give the baby extra blood cells from the placenta (delayed cord clamping). If you wish they might hold your baby up above the screen for you to see.

He or she may not cry immediately after they are born. Don't worry. The paediatrician (baby doctor) or your midwife will give them any care they need. Once baby is breathing well and looks well, they will bring baby to you. If they have concerns, they may take your baby to the Special Care Baby Unit (SCBU). As soon as they can they will tell you how your baby is and explain what they are doing

If all is well, your midwife may ask your partner if she would like 'skin to skin ' with your baby lying directly on her chest. This can help keep your baby warm and give an early time for bonding. If she does, your midwife will help get a comfortable and safe position. Otherwise your midwife can wrap your baby in a towel for you or your partner to cuddle.

As the operation finishes, a member of the team will show where you can change back into your own clothes while you wait for them.

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During an elective (planned) caesarean birth, there is usually no rush when your baby is born. If agreed beforehand, the obstetrician can lie your baby down before cutting the cord to help give the baby extra blood cells from the placenta (delayed cord clamping).

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Maidstone & Tunbridge Wells NHS Trust (February 2016)

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Baby-friendly caesarean birth | Maidstone and Tunbridge Wells NHS Trust

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Caroline Flint

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A passionate and emotive talk from Caroline Flint. A birth teaches a woman how powerful and amazing she is. So why are we treating births like a production line? Not as the most natural thing in the world.

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The Importance Of Natural Home Births | The DO Lectures

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The DO Lectures is home to the creative underdog. An encouragement network for those seeking a different path. And the idea is a simple one: to gather together the world's leading DOers, disruptors and changemakers, have them share their hearts and stories, and encourage others to DO amazing things too.

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Leah Hazard

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Pinter & Martin is an independent publishing company specialising in pregnancy, birth, parenting, breastfeeding, yoga and psychology books

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Annie Francis

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The majority of babies throughout the world are born at home and it is mainly in developed countries (and mostly in the past few decades) that going to hospital to have your baby has become the norm.

This is all set to change as more and more evidence comes to light about the positive outcomes of homebirths. With inspirational stories from women who have had successful homebirth experiences, you'll find out:

-Why women are perfectly designed to give birth
-What the evidence says about the best place to give birth
-The myths surrounding childbirth at home
-How to plan for a homebirth and what you need on the day
-What your choices of pain relief are
-What the possible risks and complications might be

Practical and reassuring, The Homebirth Handbook provides all the information you need to feel completely prepared and excited to welcome your baby in the comfort and safety of your own home.

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The Homebirth Handbook by Annie Francis | Waterstones

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The majority of babies throughout the world are born at home and it is mainly in developed countries (and mostly in the past few decades) that going to hospital to have your baby has become the norm. This is all set to change as more and more evidence comes to light about the positive outcomes of homebirths.

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Book - Inducing Labour: making informed decisions

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Book - Inducing Labour: making informed decisions

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Sara Wickham

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inducing labour: making informed decisions

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family & relationships / life stages / infants & toddlers

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Inducing Labour: making informed decisions

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Book - The AIMS Guide to Induction of Labour

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Dr Nadia Higson

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Book - Caesarean Birth, your questions answered

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Book - Caesarean Birth, your questions answered

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Debbie Chippington Derrick, Gina Lowdon and Fiona Barlow

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Caesarean Birth - Your Questions Answered