|How will I get my baby out?||| Print ||
It is natural for any woman to feel excitement tinged with a certain amount of fear when it comes to the prospect of delivering a first baby. It is only natural for you to feel some anxiety about how the delivery will go and how much it will hurt. As many babies are weighing in at well over 9 lbs, it is not surprising that you may worry about how you will ever be able to stretch to accommodate a large baby and even a small one seems an enormous challenge. With PGP these kinds of fears can increase as the pregnancy develops. You may already be finding that your mobility is limited, that you are already experiencing pain and that you cannot part your legs more than a few centimetres.
Think about your PGP and how it affects what you can and cannot do (e.g. can you lie comfortably on your back, stand unaided, walk without crutches, remain in one position?) It is unlikely that what you can and cannot do will change dramatically during labour, so it is worth noting which positions are comfortable – and which are best avoided. PGP may mean that some suggested positions for giving birth are not appropriate for you. Experiment before the onset of labour and record your preferences on your birth plan. The key to preventing stress to the pelvis is controlling the position of the legs. You should measure your ‘pain-free gap’ as the distance you can open your legs without pain and make sure that this is never exceeded. Write it in your birth plan and make sure that your birth partner and all those involved in your delivery know about it.
You should also consider what method of pain relief you would like to use. An epidural completely removes all pain but you should be aware that it not only masks the labour pains but also the pain of PGP. This means that you need to be extra vigilant about the position of your legs as you will not be aware of whether something hurts. The pain-free gap should not be exceeded and all movements need to be symmetrical. The anaesthesia of the epidural can last for some hours so you need to be aware of this after as well as during the delivery. You should also take care to be helped to change position regularly so your joints do not ‘block’ in one position.
For most women having PGP is not a reason to need a caesarean section, although there may be other factors that make it necessary, such as the position of the baby or if there are other medical problems. However, some women with PGP choose to have a caesarean section. There are valid reasons for doing so, particularly if you are very immobile, very frightened, if the delivery is likely to be problematic or if you have had a traumatic previous delivery. Choosing to have a caesarean section can be quite a contentious issue and you should take time to discuss the matter fully with your midwife/consultant. A caesarean is a major surgical procedure and as such there are risks involved. These are explained in recent NICE guidelines (www.nice.org.uk/CG013quickrefguide).
A water birth can be a great option if you have PGP. The water is warm and comforting and provides natural pain relief. Many women report a sense of freedom of movement that they haven’t experienced for some time, and it makes it very easy to change position. Most hospitals ask that you are mobile enough to get in and out of the pool without their assistance (although your partner can help) and that you are able to get out relatively quickly should an emergency arise. It is usually easy to get in if you perch on the edge of the pool with someone behind you and someone to lift your legs in, then you can slide into the water, or you can have a high stool or even a turntable board which helps you to swivel round and get in.
You can also choose to hire a birthing pool for a home birth. PGP does not mean that you cannot have a home birth. In lots of ways it is an ideal choice – you can give birth in an environment where you are comfortable and at ease, you have already assessed and dealt with any mobility and access problems and you can have people you are close to at hand to help you with your care and the baby’s care after the birth.
Birth is unpredictable and complications can and do arise. Whilst birth plans are very useful in describing concerns and wishes for the birth, it is important to remember that things don’t always go to plan. There is no right way or wrong way of giving birth and you should be prepared to be flexible as the need arises. It is worth thinking in advance about certain complications and how you would deal with them – that way you can make an informed decision at the time, should the need arise. For example: would you consent to a forceps or ventouse delivery that involved the lithotomy position? What would be the other options? You can explore the most common complications (and how you might deal with them) with your partner, midwife, consultant and other healthcare professionals in advance of going into labour.